Contraceptive and reproductive risks for cervical dysplasia in southwestern Hispanic and non-Hispanic white women.

BACKGROUND: Various contraceptive practices and reproductive factors have been associated with cervical neoplasia in case-control studies worldwide. METHODS: To investigate contraceptive and reproductive risk factors associated with high-grade cervical dysplasia in southwestern Hispanic and non-Hispanic white women, we carried out a clinic-based case-control study among university-affiliated clinic attendees. RESULTS: Oral contraceptive use ever (odds ratio [OR] = 0.4, 95% confidence interval [CI]: 0.2-0.9) and past diaphragm use (OR = 0.3, 95% CI: 0.1-0.8) were protective for dysplasia in analyses adjusted for age, ethnicity, sexual behaviour, and for cervical papillomavirus (HPV) infection. After further adjustment for Pap smear screening interval, oral contraceptive use ever remained protective for dysplasia. Vaginal deliveries were strongly associated with dysplasia with > 2 vaginal deliveries associated with a 3.9-fold increase in risk after adjustment for age, ethnicity, sexual behaviour, and HPV infection. Using logistic regression models to simultaneously control for effects of multiple factors as potentially related to cervical dysplasia, we found low educational attainment, cervical HPV infection, cigarette smoking, history of any sexually transmitted disease, and having one or more vaginal deliveries to be associated with dysplasia; oral contraceptive use and past diaphragm use also remained protective for high-grade cervical dysplasia in these regression analyses. CONCLUSIONS: The data suggest that use of oral contraceptives (ever) and past diaphragm use are protective for high-grade cervical dysplasia among Hispanic and non-Hispanic white women in New Mexico. The clinic-based perspective of this research (versus population-based studies) may help explain some of these findings.

HIV-related concerns and behaviors among Hispanic women.

Hispanic women whose sexual partners have other sexual partners may be at risk for HIV. A structured interview was administered to 106 Dominican and Puerto Rican women who reported that they knew or suspected that their partner had other partners. A subsample participated in qualitative interviews. The study assessed concern about HIV and predictors of condom use. The majority of women reported that they worried about getting HIV and almost half had been HIV-tested. Most of the women discussed HIV/AIDS concerns with their partners, and one-third reported some condom use. Predictors of condom use were: born in the Dominican Republic/Puerto Rico, having talked with their partner about being tested, and belief that he used condoms with others. Although the women were concerned about HIV, condom use was infrequent. Results suggested methods to address this discrepancy: introducing condoms early in the relationship, developing women-controlled methods, and directly influencing men's behavior.

PIP: Hispanic women in the US, especially injecting drug users and partners of infected men, have a disproportionate risk of acquiring the human immunodeficiency virus (HIV). This study focused on two groups of Hispanic women in New York City--45 Dominicans and 61 Puerto Ricans--who knew or suspected that their regular sexual partner was involved with other partners. Respondents were recruited from health clinics and social service agencies in 1992. Respondents had a relationship with their husband/boyfriend of at least one year's duration and no history of intravenous drug use. About half the women were living with their partner. 62% reported worrying "a lot" about HIV, and about half had been tested. 36% of Dominican and 33% of Puerto Rican women's partners used condoms with them; 27% of Dominican respondents and 41% of Puerto Rican women believed their partner used condoms with other partners. Logistic regression revealed that condom use was significantly more frequent among women born in the Dominican Republic or Puerto Rico as opposed to the US, women who talked to their partners about being tested for HIV, and those who believed their partner was using condoms with other women. In focus group discussions, women reported they felt more confident negotiating condom use for contraceptive purposes than for disease prevention. They further indicated it was easier to introduce condom use at the start of a sexual relationship.

Acceptability of the female condom among STD clinic patients.

This study examines the acceptability of the female condom among African American and Latino patients from two inner-city sexually transmitted disease (STD) clinics through focus group discussions. Prior to the initial focus group sessions, 90% (n = 90) had heard about the female condom, 8% (n = 8) had seen it, and 2% (n = 2) had used it. Among the 41 participants (22 males and 19 females) attending a second focus group session, 85.4% (n = 35) had used the female condom at least once. Female study participants who had previous experience inserting a barrier contraceptive device, such as a diaphragm, indicated that they felt more comfortable inserting the female condom than those who had never used such a device. Male participants indicated that they were more comfortable using the female condom with their steady partners than with casual partners, whereas female participants indicated no such distinctions. These and other study findings suggest that need to promote and expand the use of the female condom as a device that protects women from STD transmissions including HIV and AIDS.

PIP: The acceptability of the female condom was explored through mixed-gender focus group discussions involving 100 Black and Hispanic men and women recruited from two US inner-city sexually transmitted disease clinics. Before the initial group sessions, 90 participants (90%) had heard about the female condom, 8 (8%) had seen it, and 2 (2%) had used the device. Female participants initially reacted negatively to the condom's appearance, size, and obtrusiveness and expressed uncertainty about how it could be inserted. Male participants, on the other hand, focused on utilitarian rather than aesthetic issues. After handling the device, more than half of female and male participants endorsed a more positive attitude. Women with previous experience with a barrier contraceptive device such as the vaginal diaphragm were more likely to feel comfortable about female condom use. Among the 22 males and 19 females who returned for a second group session after having been given a supply of female condoms to try, 35 (85.4%) had used the device at least once. 10 participants noted that bringing up the topic of female condom use enabled them to discuss safer sex practices with their steady partners for the first time. Women who, in the initial discussions, viewed the female condom as a means of gaining control over their sexuality, gained awareness of the need for substantial male support and cooperation. Men were more comfortable using the device with regular than casual partners, but women made no such distinction. Although it is acknowledged that participants who returned for the second discussion may have had more favorable experiences than those who did not, the preliminary data suggest that the female condom is acceptable to men and women at risk of HIV. HIV/AIDS prevention campaigns aimed at promoting female condom use should address the technical skills and knowledge of female anatomy needed for method use, empowerment and negotiation skills, and ways to eroticize female condom use.

HIV-related attitudes and risk behavior of young adolescent mothers.

This article reports on the prevalence of HIV-related risk behaviors among young adolescent mothers. To determine the facilitators and barriers to condom use for young adolescent mothers, a survey of HIV-related knowledge, attitudes and behavior and focus groups was conducted. Young mothers (N = 58) have basic knowledge and some personal concern about HIV, but also hold common misconceptions about HIV and people with AIDS. Despite their anxiety about HIV, almost half rarely or never protect themselves against HIV by using a condom. Although 70% of the sample use hormonal contraceptives, more than one third of the sample have had a second child within an average of 18 months after the birth of their first baby. Personal concern about HIV was significantly associated with consistency of condom use. Because of low rates of condom use and substantial rates of multiple sex partners, STDs and second pregnancies, disadvantaged adolescent mothers are at risk of exposure to HIV. Increased personalized concern for HIV may lead to greater motivations for safer behavior for these mothers. In addition to protecting their own safety, the protection of their child may be an important motivator for safe behavior. Cultural taboos against safe sex and the perception of such behavior as "unfeminine" also need to be addressed for these women.

PIP: HIV-related knowledge, attitudes, and risk behaviors were investigated in a study of 58 primarily Latina, low-income adolescent mothers (mean age, 17.5 years) enrolled in the Rhode Island (US) Hospital Teen-Tot Clinic. Respondents expressed fear concerning the threat of AIDS and 9% were worried they had already been exposed to HIV. Their basic knowledge about HIV transmission was adequate. Despite substantial anxiety about HIV infection, 47.4% of teen mothers did not use condoms consistently, 31.7% had 2 or more sex partners in the past year, 14.0% had a history of a sexually transmitted disease, and 22.8% had intentionally cut their body with an instrument such as a razor blade or pen. Although 70% used hormonal contraception, 33% of respondents had a second child within an average of 18 months of the birth of the first. Consistent condom users were significantly more likely than those who almost never or never used condoms to report personalized anxiety and concern about HIV/AIDS, significantly less likely to engage in self-mutilating behaviors, and significantly more likely to express intentions to engage in future HIV prevention behaviors. In focus groups discussions attended by 59 respondents, teen mothers expressed a sense of powerlessness in negotiating condom use with older male sexual partners and cultural taboos against condom use in primary relationships. Latinas viewed assertive sexual decision-making as incompatible with cultural norms regarding the female role. While hormonal methods of contraception were perceived as a medical regimen, barrier methods were associated with a culturally unacceptable premeditated decision to have sex.

AIDS knowledge and risk behaviors among culturally diverse women.

This article reports results from a survey of women at risk for HIV infection. The sample (n = 620) included black (50.6%), white (28.7%), Hispanic (13.4%), and Haitian (5.0%) adult women from south Florida. Data concerning their AIDS knowledge, prevalence of risk behaviors, and perceived vulnerability are presented. Results indicate differences in certain knowledge areas and risk behaviors by race/ethnicity and a consistent incidence of unprotected sex with their main partners across all racial/ethnic groups.

PIP: Florida has the 3rd highest cumulative number of AIDs cases among states in the US, and 12% in Florida are women, which is 3% higher than the national average. The study describes the AIDs knowledge and sexual behavior of women at high risk of HIV infection in 1989 from Dade and Broward counties in Florida. As part of a 3-year project, it was designed to develop a cross sectional description of women at risk, and to develop and evaluate interventions aimed at perinatal AIDs prevention. 620 nonpregnant women were recruited from county jails and detention centers (59.3%), county health, STD, and family planning clinics (26%), alcohol/drug treatment centers (13.6%), and other (1.1%). The mean age of respondents was 28.9 years. 51% were never married, and 76% had 1-3 children. 45% were unemployed. 21% reported income from prostitution and 17% from illegal activity. 44% had ever engaged in prostitution. 83% had used an illegal substance of which 22% was IV drugs. 8.7% were seropositive. 71% received AIDs, STDs, contraception, and sexuality information from the mass media, and 59% from medical professionals and public health clinics. The limitations were the representatives of the sample, and the validity and reliability of the questionnaire. The results of AIDs knowledge, risk behavior, and vulnerability revealed that the majority were well informed about AIDs and HIV infection, with the exception of Haitians. The findings support treating Haitian women as a special population for AIDs prevention programs. Those 20 and 41 years tended to believe myths about AIDs and casual contact and perceived risk based on the appearance of an individual. 75% were unaware of bleach as a remedy for dirty needles. As a subcultural influence, people need more knowledge about safer drug use. Knowledge did not influence risky behavior. Transmission appears to be from heterosexual contact. A greater prevalence of sexual risk behavior was reported with main partners even though 75% agreed one couldn't trust lovers in reporting STDs. Program focus on prostitutes may have limited impact. Hispanics reported the greatest prevalence of risk behaviors, followed by whites, blacks, and Haitians. Over 40% of Hispanic and Haitian and 20% of black women reported intention to not use a condom with a seropositive partner. Economics and gender role norms are a great influence. There was a general lack of perceived vulnerability. Successful community and society level strategies involve continued education, sociocultural sensitivity, gender role issues, sexual decision making, and economic factors.

Norplant use among urban minority women in the United States.

The aim of this study was to develop a profile of urban American women who chose Norplant(R), determine factors associated with retention and early termination of implants, and to determine reasons for early removal. A total of 197 adult black and Hispanic women who had Norplant inserted were followed prospectively for up to 5 years. Interval and cumulative termination rates were calculated. Data were stratified by race and analyzed to include lost-to-follow-up (LTFU) subjects. Multivariate survival analysis was used to determine variables independently associated with termination. Cumulative continuation rates were 68% after year 1 and 13% after year 4. Significant predictors of retention included black race and lower parity. Probability of early termination increased with higher parity and Hispanic race. For black subjects, recent use of hormonal contraception was a predictor of retention. Menstrual changes and weight concerns were common reasons for removal. The Norplant 1-year continuation rate is lower than previously reported, but is higher than reported for oral contraceptives and Depo-Provera(R). Future studies should stratify by age, race, and parity, and use standardized terminology to report intervals of use.

Contraceptive use among Latina women: social, cultural, and demographic correlates.

PIP: This study examined attitudes toward contraceptives and their use among Latino women recruited from obstetrics/gynecology waiting rooms in Los Angeles, California. Interviews were conducted among 291 Latino women aged 15-50 years who were not pregnant or planning to become pregnant. Most Latino women were ranked low on acculturation. Barriers to contraceptive use (CU) were measured on the Meyers and Rhodes scale of 13 barriers. Attitudes were assessed with a modified UCLA Multidimensional Condom Attitudes Scale. The mean age was 29.5 years. 91% were born outside of the US. 50% were married. 68% reported CU during each sexual act. 74% reported intention to use during each future sexual act. 71% were very certain they would use birth control during each sexual act over the next 6 months. 89% reported at least 1 barrier to CU. 48% reported that contraceptive responsibility was a women's role. 42% reported opposition to use of birth control by their partner. 35% had the attitude that sex was more romantic without contraception. CU was highest among women aged 31-40 years, non-natives of the US, with 1 or more children, without a desire for more children, with fewer barriers to CU, with high social support for CU, with low levels of economic stress, and with low acculturation. The multivariate model with controls for confounders revealed that CU was associated with no desire for additional sons, social support, self efficacy, and low acculturation.^ieng

Births to unmarried mothers: trends and obstetric outcomes.

PIP: This study examines trends in nonmarital childbearing among women who represent an inner-city urban population that includes high-risk privately insured mothers and a large number of indigent mothers. The study population includes data collected from a computerized database at the MetroHealth Medical Center in Cleveland, Ohio, during 1974-93, on 73,544 births. The subsample for the clinical analysis is based on 29,865 deliveries that occurred during 1987-93. Findings indicate that the proportion of deliveries to unmarried mothers increased by at least 20% over a 19-year period. The proportion of privately insured unmarried mothers increased from 6.7% to 27.3% during 1975-93. The proportion of staff-funded mothers increased from 63.5% to 77.5%. The proportion increased for all races, funding groups, and age groups. In the subsample of births during 1987-93, there were 51% Whites, 38% Blacks, 8% Hispanics, and 3% other. Only 15% had private medical insurance. 34.2% of births were to married mothers. 38% of births were to women who were smokers, 3.2% were alcohol users, and 15.4% were narcotic users. 15.4% were cesarean births. The infant mortality rate was 13/1000 live births. Unmarried mothers tended to be about four years younger than married mothers. Over 30% of unmarried mothers and only 10% of married mothers were teenagers. 48% of White mothers, 14% of Black mothers, 35% of Hispanic mothers, and 70% of mothers of other race were married at the time of delivery. The mean birth weight for unmarried mothers was 100 g less than for married mothers. Significant predictors of mothers' marital status were insurance status, race, age, and their interaction. The odds of unmarried status increased with younger age, delivery later in the study period, race, insurance pay status, and parity, which, when controlled for, showed Black and Hispanic mothers with increased odds of an unmarried status. Significantly more unmarried mothers had infants with thick meconium, premature delivery, and fetal distress among neonates.^ieng

Patterns of contraceptive use and pregnancy among young Hispanic women on the Texas-Mexico border.

Our objective was to identify significant family planning and health access problems of young Hispanic women on the Texas-Mexico border. Samples of 300 young Hispanic women living in each of the twin cities of El Paso and Juarez were interviewed regarding their knowledge, attitudes, and experiences with respect to birth control, pregnancy, maternal and child health, and health-care services. Knowledge and attitudes of the women about birth control technology were assessed along with their beliefs regarding the use of such technology. Results showed that contraceptive knowledge and usage patterns for young Hispanic women in Juarez and El Paso were significantly different. They relied on different types of birth control methods and also differed with respect to confidence in these methods and related medical services. Both groups reflected positive attitudes toward both child bearing and use of birth control although Juarez women were significantly more favorable toward child bearing. Both groups overwhelmingly favored female doctors. The young women studied have accepted the need for birth control, prefer fewer children, and have some degree of confidence in medical services. Their knowledge and use of reliable versus unreliable birth control devices appear to be major areas requiring culturally sensitive intervention.

PIP: Social work students administered a questionnaire to 600 randomly selected adolescent females from El Paso, Texas, and Juarez, Mexico, to examine their knowledge and use of contraceptive methods and their attitudes about pregnancy, contraception, and child care. 11.7% of the El Paso respondents and 16.7% of the Juarez respondents had been pregnant at some time. Oral contraceptives (OCs) were the most known contraceptive method. Women in El Paso were more likely to be familiar with OCs (98% vs. 91.3%), condoms (93.7% vs. 74.7%), vaginal methods (79.7% vs. 67.8%), and withdrawal (65.3% vs. 44.5%) than were those in Juarez (p = .001). On the other hand, more Juarez women than El Paso women knew about injectables (79.8% vs. 34.1%), sterility or tubal ligation (89.9% vs. 63.3%), vasectomy (73.2% vs. 69%), Billing's method (19.2% vs. 5.3%), and the rhythm method (73.6% vs. 36.4%) (= = .001). Many women from both cities used ineffective methods. Women in Juarez were much more likely to use the rhythm method than those in El Paso (26.4% vs. 3.4%; p = .001). Women from both cities, particularly those in Juarez (p = .001), believed more information on contraception was needed. They felt strongly that men should also be responsible for family planning and approve of women using contraceptives. They believed that couples should have fewer children. Juarez women has a more positive view of pregnancy and childbearing than did El Paso women. El Paso women were more likely to visit a physician in the last year for reasons other than check-ups (mean number of visits, 1.88 vs. 1.25; p = .005). Most women preferred to receive maternal and child health/family planning services from a female physician (56% in Juarez and 64.3% in El Paso). These findings indicated that cultural differences in contraceptive knowledge and usage as well as confidence in various methods and related medical services existed. They emphasized the need for culturally relevant education, research, and service programs concerning adolescents in the Texas-Mexico border region.

Contraceptive implant use among inner city teens.

PURPOSES: This study develops a clinical profile of urban teens who selected Norplant for contraception; determines which variables identify the subjects most likely to be compliant with the method; and determines the most common reasons for early termination of use. METHODS: Demographic and health history data and reasons for termination of use were collected prospectively for 122 inner city teens who received Norplant. Life table analysis and the Mantel-Haenszel procedure were used to investigate differences between Norplant retainers and terminators. RESULTS: The sample consisted of black and Hispanic teens between the ages of 13-19 years, the majority of whom had one or more children and were in school. One and two year retention rates were 71% and 62%. The highest removal rates occurred during the 3-6 month interval after insertion. A significant finding was that teens who have experienced induced abortion were more likely to retain Norplant. Common reasons for termination of use included general and social concerns, including pregnancy desire. CONCLUSIONS: Norplant retention rates for this teen sample were greater than the compliance rates reported for other conventional methods. Similar to noncompliance with oral contraceptives, discontinuance of the method was most likely to occur in the first 6 months of use. A history of induced abortion identifies those teens most likely to retain Norplant, suggesting that these teens might evaluate contraceptive risks and benefits differently than those with no abortion history. Pregnancy desire was a common reason for terminating Norplant use.

PIP: This prospective study of 122 Black and Hispanic inner-city adolescent Norplant users recruited from a teen clinic in Rochester, New York, was the first to include a two-year follow-up period. The study period extended from June 1, 1991, to June 30, 1993. The mean age of Norplant acceptors was 17.4 years; 76% had a parity of at least one. Recorded was a one-year retention rate of 71% and a two-year rate of 62%. The greatest number of removals occurred in the first three months after insertion. There was no association between Norplant retention and age, weight, race, parity, or school status. The only significant predictor of Norplant continuation was a history of at least one induced abortion. The reasons most frequently cited by the 30 adolescents who discontinued Norplant were headache, fatigue, hair loss, nausea, weight changes, breast symptoms, and appetite changes. Menstruation irregularities were reported only by terminators in the 3-6 month use interval. Considering the high continuation rates recorded in this survey and the method's proven effectiveness, Norplant has the potential to widen substantially the birth interval between adolescent pregnancies.

Condom use by Hispanic and African-American adolescent girls who use hormonal contraception.

PURPOSE: The purpose of the present study was to examine condom use by teens who use hormonal contraceptives [i.e., Depo-Provera, Norplant, or oral contraceptives (OCs)]. METHODS: This is a cross-sectional study of 578 Hispanic and African-American female adolescents between the ages of 12 and 21 years who came to a reproductive health care clinic. A paper-and-pencil questionnaire which addressed sexual behaviors, sexual history, and communication about sexuality was distributed to adolescent girls attending the clinic. Several important analyses included only those who had been sexually active in the last 4 weeks (n = 452). RESULTS: Adolescents who used OCs [odds ratio (OR) 1.7], long-acting agents (i.e., Depo-Provera or Norplant) (OR 1.6), were less likely to have used a condom in the last 4 weeks than teens whose only method of birth control was condoms. Only those teens who had previously been diagnosed with a sexually transmitted disease (STD) were more likely to have used a condom (OR .67 for not using a condom). Overall, condom use by teens in this sample was low, with only 19% reporting that they "always" use a condom, and 47% of the teens who had been sexually active in the last 4 weeks reporting that they had not used a condom at least once during that time. CONCLUSIONS: This study provides data which suggest that adolescent girls who use hormonal contraceptives are less likely to use condoms than other sexually active teens. Therefore, when prescribing hormonal contraception to prevent pregnancy, clinicians must provide appropriate counseling to mitigate against the potential to increase the risk of STDs.

PIP: AIDS is the leading cause of death among people 25-44 years old, with young women comprising the largest category of new AIDS cases. Minority women are at greatest risk of HIV infection; nationally, 1% and 0.5% of African-American and Hispanic women, respectively, aged 27-39 years may be infected. A cross-sectional study of 578 Hispanic and Black female, sexually experienced adolescent users of hormonal contraceptives aged 12-21 years who came to a reproductive health care clinic were surveyed about their condom use, for the correct and consistent use of condoms can reduce the risk of contracting HIV through sexual contact. 54% of the women reported that they have sexual intercourse at least once per week, 12% had intercourse daily, and 32% had had 4 or more lifetime sex partners. Adolescents who used OCs and long-acting hormonal contraceptive agents were less likely to have used a condom in the past 4 weeks than teens whose only method of birth control was condoms. Only those women who had previously been diagnosed with a sexually transmitted disease (STD) were more likely to have used a condom. Overall condom use by teens in the sample was low, with only 19% reporting that they always used a condom, and 47% of the teens who had been sexually active in the past 4 weeks reporting that they had not used a condom at least once during that time. Family planning providers must counsel their clients who use hormonal contraceptives on the need to also protect themselves against HIV and other STDs.

Why woman partners of drug users will continue to be at high risk for HIV infection.

Women infected with Human Immunodeficiency Virus (HIV) via a sexual relationship with an infected drug using partner are the second largest group of women diagnosed with AIDS in this country. Since 1983, they have been the most rapidly growing subgroup of adults with AIDS, and the increase has been even more rapid among black and hispanic women. Because they are a diverse group and are not readily identified, women partners of drug users and their needs have been unknown to or neglected by service providers and programs that could help them avoid becoming infected. More complete understanding of their characteristics and needs can help in the development of sensitive educational, preventative, and therapeutic strategies to help slow the dramatically increasing burden of AIDS-related morbidity and mortality among them and their families.

PIP: Women who acquired HIV from their IV drug user sexual partners make up the 2nd largest group of women with AIDS in the US. By May 1991,k more than 3600 women had AIDS due to sexual intercourse with an IV drug user. Yet this is a low estimate because women partners of IV drug users are not visible and either do not know or want to know about their sexual partners drug use, but women partners of IV drug users constitute the fastest growing subgroup of adults with AIDS since 1983. The rise is particularly quick among black and hispanic women. They come from all racial, ethnic, and social group and tend to abuse alcohol and drugs but not usually IV drugs. Those in urban areas tend to be of reproductive age, have children, and are poor. Due to their diversity and their relative invisibility, service providers and programs that can help them avoid acquiring HIV infection either cannot identify them or their needs or they neglect them. The most successful HIV prevention programs are those designed and managed by women peers. HIV prevention programs based in drug treatment programs used by the women's partners and in AIDS-related programs have not been successful. Prevention messages geared towards women have tended to focus on condom usage and prevention of HIV transmission to infants without considering their social and psychological needs. They need prevention methods which they can control. Use of existing methods (e.g., asking a partner to use a condom) may result in various reactions such as sexual rejection and domestic violence. Thus providers must become more familiar with their characteristics and needs to develop sensitive educational, preventive, and therapeutic approaches to reduce the burden of AIDS-related sickness and death among women partners of IV drug users and their families.

Mexican cultural beliefs and breastfeeding: a model for assessment and intervention.

This article describes a model which organizes beliefs and practices of women of Mexican descent and describes counseling approaches for each. The four categories of beliefs and practices are beneficial, harmless, harmful and uncertain. Counseling ideas for each of the categories includes approaches to encourage, ignore, dissuade or observe to categorize the belief later. Situational examples correspond to each category to illustrate how the model can be incorporated into practice. The model provides a methodology for assessment and intervention which considers and respects the cultural elements that influence breastfeeding.

PIP: Part of an effort to improve breastfeeding counseling for women of Mexican descent, this article categorizes this cultural group's practices and beliefs that pertain to breastfeeding, and suggests appropriate counseling approaches. Beliefs and practices fall under the categories of beneficial, harmless, harmful, and uncertain. Respectively, counselors should encourage, ignore, dissuade, or observe for future classification each of the categories. Certain beliefs--like the idea that drinking atole, a cornmeal beverage -- neither jeopardize nor benefit the practice of breastfeeding. Therefore, a counselor can safely ignore this harmless belief. Other beliefs, however, do prove harmful for breastfeeding, such as the notion that a sudden shock or emotional upheaval (coraje or asusto) spoils the milk. While harmful beliefs need to be discouraged, the counselor should do so in a culturally sensitive manner. For example, instead of completely discounting the belief, counselors can avert the harmful effects of coraje or asusto by suggesting to the mother to discard the "old, bad" milk and resume breastfeeding the baby with "new" milk. Some beliefs, such as idea that a woman's shoulders must be covered to maintain an adequate milk supply, cannot yet be categorized. While body warmth helps milk production, the belief could become counterproductive if taken to the extreme -- if women believe that they can only breastfeed when their shoulders are covered. Beliefs under this category demand further observation. Lastly, counselors should encourage beneficial beliefs, such as the practice of cuarentena, where the 40 days following the baby's birth provide the mother, among other things, rest and a special diet. When dealing with any category, counselors should keep in mind that these beliefs are oftentimes centuries old, and should therefore approach them in a sensitive manner.

Physical abuse, smoking, and substance use during pregnancy: prevalence, interrelationships, and effects on birth weight.

OBJECTIVE: To establish the singular and combined occurrence of physical abuse, smoking, and substance use (i.e., alcohol and illicit drugs) during pregnancy and its effect on birth weight. DESIGN: Prospective cohort analysis. SETTING: Urban public prenatal clinics. PARTICIPANTS: 414 African American, 412 Hispanic, and 377 white pregnant women. MAIN OUTCOME MEASURE(S): Occurrence of physical abuse was 16%; smoking, 29.5%; and alcohol/illicit drug use, 11.9%. Significant relationships existed between physical abuse and smoking for African American and white women. For African American women, 33.7% of women who were not abused smoked, versus 49.5% of women who were abused (chi 2 = 8.21; df = 1; p < 0.005). Alcohol/illicit drug use was 20.8% for nonabused women compared with 42.1% for abused women (chi 2 = 18.18; df = 1; p < 0.001). For white women, 46.6% of women who were not abused smoked, versus 59.6% of those who were abused (chi 2 = 5.22; df = 1; p < 0.005). As a triad, physical abuse, smoking, and alcohol/ illicit drug use were significantly related to birth weight (F[3, 1040] = 30.19, p < 0.001). CONCLUSIONS: Physical abuse during pregnancy is common, readily detected with a five-question screen, and associated with significantly higher use of tobacco, alcohol, and illicit drugs. Clinical protocols that integrate assessment and intervention for physical abuse, smoking, and substance use are essential for preventing further abuse and improving smoking and substance cessation rates.

PIP: Using a prospective cohort analysis, this study established the singular and combined occurrence of smoking, physical abuse, and substance use during pregnancy and its effect on birth weight among African American, Hispanic, and White women. The sample consisted of 1203 African American (n = 414), Hispanic (n = 412), and White (n = 377) pregnant women from urban public prenatal clinics in Houston and Baltimore. In the results, occurrence of physical abuse was 16%; smoking, 29.5%; and alcohol/illicit drug usage, 11.9%. Among African American and White women, significant relationships existed between physical abuse and smoking. About 33.7% of African American women, who were not abused, smoked compared with 49.5% of women who were abused. Alcohol/illicit drug use was 20.8% for nonabused women compared with 42.1% for abused women. Moreover, the three characteristics--physical abuse, smoking, and alcohol/illicit drug use--were significantly related to birth weight. The results indicate that abuse during pregnancy is associated with increased smoking, and use of alcohol and illicit drugs. Thus, clinical protocols integrating assessment and intervention for physical abuse, smoking, and substance use are needed to achieve healthy outcomes for pregnant women and their infants.

The effects of childhood sexual abuse on minority adolescent mothers.

OBJECTIVE: To examine the incidence and effects of childhood sexual abuse experiences on the lives of adolescent mothers who were Mexican American and African American. Specifically, the personality characteristics of the adolescent mothers who experienced sexual abuse as assessed using the Millon Adolescent Personality Inventory were compared with those of minority adolescent mothers who were not abused sexually. DESIGN: An exploratory descriptive design. SETTING: Four public agencies caring for adolescent mothers in two urban centers in Texas. PARTICIPANTS: Mexican American and African American adolescent mothers (N = 124), ages 13-20 years. MAIN OUTCOME MEASURES: The Millon Personality Inventory, the Life Event Scale-Adolescents, the Childhood Sexual Experience Survey, and a demographic data sheet. RESULTS: Forty-four percent (n = 54) of the respondents reported childhood sexual abuse experience. Data from 111 subjects (two groups, abuse and nonabuse) were analyzed by MANCOVA techniques. Significant differences were found between the two groups when the effect of the Life Event Scale-Adolescents was controlled (Multivariate F[12, 97] = 3.055, p = 0.001). Univariate F tests (df1, 108) showed significant differences in self-concept (F = 18.434, p < 0.000), personal esteem (F = 8.819, p = 0.004), body comfort (F = 10.442, p = 0.002), sexual acceptance (F = 9.918, p = 0.002), peer security (F = 10.412, p = 0.002), family rapport (F = 9.801, p = 0.002), academic confidence (F = 5.764, p = 0.018), social conformity (F = 4.552, p = 0.035), scholastic achievement (F = 19.991, p < 0.000), and attendance consistency (F = 10.009, p = 0.002). The mothers in the abuse group had consistently poorer scores than those in the nonabuse group. CONCLUSIONS: These findings suggest that childhood sexual abuse may be related to vulnerability for adolescent motherhood.

PIP: In 2 urban areas of Texas, 124 mothers, 13-20 years old, all but 6% of whom were Mexican American or African American, were recruited from 4 public agencies to a study designed to determine the incidence and effects of childhood sexual abuse on the lives of these adolescent mothers. The study used the Millon Adolescent Personality Inventory (MAPI) to compare the personality characteristics of those mothers who had experienced sexual abuse with their nonabused counterparts. Most adolescent mothers were single (80%), lived with their parents (63%), were pregnant for the first time (56%), currently attended school (84%), and lived in a family whose annual income was less than $12,000. 44% of the mothers had experienced some form of childhood sexual abuse. More than 50% reported oral, anal, or vaginal intercourse with their abusers. The abusers tended to be male (97%) and known to the victim (66%). Male strangers accounted for 19% of abusers. The researchers were able to use data from 111 subjects to compare the 2 groups. The abused adolescent mothers always had clinically and statistically significant poorer scores than nonabused mothers. Abused mothers had greater difficulties in self-concept (p 0.0001), self-esteem (p = 0.004), body comfort (p = 0.002), sexual acceptance (p = 0.002), peer security (p = 0.002), and family rapport (p = 0.002). They also had clinically significant lower levels of academic confidence (p = 0.018), social conformity (p = 0.035), scholastic achievement (p 0.0001), and attendance consistency (p = 0.002). When researchers controlled for the effect of the Life Event Scale-Adolescents, abused mothers had differences that were significantly different than those of nonabused mothers (p = 0.001). These findings suggest that nurses within prenatal or well-baby care agencies should guide adolescent mothers who experienced childhood sexual abuse as they learn to communicate with their family or refer them to existing support services. It is important to ask adolescent mothers about a history of sexual abuse.

Family planning needs and behavior of Mexican American women: a study of health care professionals and their clientele.

"A random sample of Mexican American women and a sample of family planning health care professionals, both from two major southwestern cities in the United States, were compared in terms of their reports of birth control methods used, problems in obtaining family planning services, and values involved in making fertility-related decisions, within the Mexican American population.... While there were points of agreement between the two samples, discrepancies were found in reports of problems in obtaining family planning services, fertility-related values, and in the acceptability of female sterilization as a birth control method. It was concluded that family planning professionals in these service areas tend to stereotype Mexican American women, and may not yet realize that the family planning attitudes and behavior of these women are probably changing in significant ways." (SUMMARY IN SPA)

Dominican, Mexican, and Puerto Rican prostitutes: drug use and sexual behaviors.

PIP: HIV-related behaviors are reported in three groups of Hispanic prostitutes recruited in the US: 77 Dominicans recruited in the Washington Heights/Inwood section of New York City; 151 Mexicans recruited in El Paso, Texas; and 48 Puerto Ricans recruited in East Harlem, New York City, during 1989-91 in streets and brothels. Ethnographic interviews were conducted with a subsample of subjects (10 Puerto Ricans, 20 Mexicans, and 20 Dominicans) to examine the cultural meaning of risk behaviors. Structured interviews based on the NIDA AIDS Initial Assessment were conducted with the subjects to describe demographic characteristics and summarize levels of risk behaviors. Qualitative data showed that for the Mexican women in El Paso poverty, violence, drug dealing and transport, tourist clients, and an environment of illegality were the realities more than for the Dominican and Puerto Rican prostitutes. The Dominican sample in New York City transported to their new environment strong family values and proscriptions against drug use as well as prostitution in brothels on account of poverty-related motivations for the support of their children. The Puerto Rican women reflected acculturation evolved in two locations, as well as illicit drugs, violence, and abuse. 92% of the Dominican women, 71% of the Mexican women, and only 25% of the Puerto Rican women were born in their native countries. Only 10% of the Puerto Ricans, 36% of the Mexicans, and 53% of the Dominicans always used condoms. 58% of the Puerto Ricans, 21% of the Mexicans, and 13% of the Dominicans reported ever having a sexually transmitted disease (p 0.001). Of those tested by the project, only 2% of the Mexicans vs. 8% of the Dominicans were HIV positive. Among drug-addicted Puerto Ricans, the HIV seroprevalence rate was 40-50%. 79% of the Puerto Rican prostitutes were sex partners of iv drug users. For effective prevention, cultural diversity must be taken into account.^ieng

Birth control and low-income Mexican-American women: the impact of three values.

PIP: This study examines how 3 particular sociocultural values affect Mexican-American women's attitude, knowledge, and use of birth control. Researchers interviewed 99 low-income married Mexican-American women, 48 of whom had a low level of acculturation and 51 of whom had a high level, focusing on the values of motherhood, male dominance, and sexual expression. While the low acculturation group showed a significant linear relationship between attitudes towards birth control and the 3 values, the high acculturation group failed to exhibit a similar relationship. The study also found that no significant relationship exists between knowledge of birth control and the aforementioned values. The sociocultural values, however, do explain a 30% variability in attitudes towards birth control among the women with low acculturation, as well as a 22% variability in birth control use. Although significant, the results do not fully account for the variability. The study suggests several possible explanations for the unaccounted variance: considering the complexity of the values involved, the instruments involved may have failed to fully uncover their effects; because they were normed on Anglo-Americans, the instruments may not have sensitive enough of Mexican-American attitudes; and finally, the study may have overlooked other important values. Nonetheless, the study points out definite differences in attitudes between high and low acculturation groups. Considering that Hispanic women -- particularly Mexican-American women -- experience a very high birthrate (double that of non-Hispanics), examining sociocultural values may give insights into better family planning methods for this group.^ieng

Social science stereotypes of the Mexican American woman: policy implications for research.

PIP: Reviewing the social science literature on the Chicana or Mexican American woman reveals a tenaciously perpetuated stereotype in which she appears almost exclusively as a submissive maternal figure. This may be related to an on-going trend to support studies of interpersonal or cultural characteristics of Chicanas and a resistance to undertake evaluations of systemic discrimination against Mexican American women. Almost all such studies investigated lower class samples, thus confounding ethnicity with socioeconomic status. The size and selection of many of the samples are questionable for purposes of generalizing to the entire population. Because many concepts are not defined in behavioral terms, they are seldom assessed empirically. The main concern is to what extent social scientists and the media are dictating norms to the Chicano family and to what extent are social planners and educators being influenced by these images. Examples from 3 distinct areas of research conclude with interpretations of Mexican American women that differ considerably from those with a heavy emphasis on cultural values: 1) demographic analyses of the 1970 Public Use Samples of the census that acknowledge the disadvantaged economic position of Mexican Americans; 2) studies that are beginning to measure empirically the family dynamics of Mexican Americans; and 3) family planning studies that attempt to examine the interaction between health care delivery systems and Mexican American contraceptive behavior. Trained and experienced Chicana researchers are needed to offset the male orientation and ethnocentrism that have characterized the social sciences.^ieng

Risk assessment for human immunodeficiency virus among pregnant Hispanic adolescents.

Inner-city adolescents are believed to be at increased risk for HIV infection because of their high-risk behaviors, and black and Hispanic teenagers may be at greatest risk as a consequence of these behaviors and inadequate AIDS education. In the present paper, the HIV risk status of pregnant Hispanic adolescents presenting for prenatal care to an inner-city municipal outpatient clinic located in New York City was assessed. The assessment consisted of a confidential structured interview. Based on known adult risk factors, adolescents were identified as being at increased risk or low risk. One-third of the 87 teenagers were identified as being at increased risk for HIV infection. Nobody reported symptoms suggestive of AIDS, had had a transfusion, or reported use of intravenous drugs or crack cocaine. Sexual risk-taking behavior was the most common factor that increased HIV risk. Sixteen adolescents were at increased risk solely because of a sexually transmitted disease and seven others reported an STD with at least one other risk factor. Although 86% of the pregnant teenagers reported the risk-taking behavior of substance use by self or partner, only four were at increased risk based on this factor alone. However, many adolescents were unaware of their partners' past substance use and sexual history and, therefore, may have underestimated their own risk. Birthplace (United States vs. foreign born) and nationality (Puerto Rican vs. non-Puerto Rican Hispanic) were significantly associated with the adolescents' HIV risk assessment via an interaction effect. None of the adolescents had previously considered themselves to be at increased risk for HIV infection. The overwhelming majority who were at increased risk declined referral for further counseling or testing. It is recommended that pregnant Hispanic adolescents be assessed for HIV risk and receive risk reduction counseling as part of their general health care.

PIP: Blacks and Hispanics have disproportionately higher rates of AIDS than do Whites, and they have the highest rates of heterosexually acquired AIDS. Inner-city teens' high-risk behaviors particularly predispose them to the risk of HIV infection. This paper presents findings from an assessment of HIV risk status of 87 pregnant Hispanic adolescents presenting for prenatal care at an inner-city municipal outpatient clinic in New York city. Participants were aged 13-19 years, of mean age 17.3 years, and evaluated and interviewed from May 1989 through November 1990. Their sexual partners were of average age 20.9 years. 57 (66%) reported never having used any form of contraception; only 3 of the remaining 30 girls used condoms. Only 29 of the 87 girls (33%) were, however, deemed to be at increased risk of HIV infection. It should be noted that lack of some respondent knowledge on partners' past substance use and sex history may result in the overall level of risk being understated. Nobody reported symptoms suggestive of AIDS, had had a transfusion, or reported use of IV drugs or crack cocaine. Sexual risk-taking behavior was the most common factor increasing HIV risk in the sample. 16 girls were at increased risk exclusively due to the presence of sexually transmitted diseases (STD), while 7 others reported an STD with at least one other risk factor. Further, 86% reported risk-taking substance use by themselves or partners, but only 4 were at increased risk due exclusively to this factor. Birthplace and nationality interacted to be significantly associated with the risk of HIV infection. Non-Puerto Rican Hispanics born in the US were more likely to be at increased risk for HIV than were those born in their native land. It is stressed in closing that while none of the girls had previously thought of themselves as being at increased risk for infection, and the majority at increased risk of infection declined referral for further counseling or testing, pregnant Hispanic adolescents should nonetheless be assessed for HIV risk and receive risk reduction counseling as part of their general health care.