Childhood sexual abuse and pervasive problems across multiple life domains: Findings from a five-decade study.

The aim of this study was to use longitudinal population-based data to examine the associations between childhood sexual abuse (CSA) and risk for adverse outcomes in multiple life domains across adulthood. In 937 individuals followed from birth to age 45y, we assessed associations between CSA (retrospectively reported at age 26y) and the experience of 22 adverse outcomes in seven domains (physical, mental, sexual, interpersonal, economic, antisocial, multi-domain) from young adulthood to midlife (26 to 45y). Analyses controlled for sex, socioeconomic status, prospectively reported child harm and household dysfunction adverse childhood experiences, and adult sexual assault, and considered different definitions of CSA. After adjusting for confounders, CSA survivors were more likely than their peers to experience internalizing, externalizing, and thought disorders, suicide attempts, health risk behaviors, systemic inflammation, poor oral health, sexually transmitted diseases, high-conflict relationships, benefit use, financial difficulties, antisocial behavior, and cumulative problems across multiple domains in adulthood. In sum, CSA was associated with multiple persistent problems across adulthood, even after adjusting for confounding life stressors, and the risk for particular problems incremented with CSA severity. The higher risk for most specific problems was small to moderate, but the cumulative long-term effects across multiple domains reflect considerable individual and societal burden.

Disparities in the pace of biological aging among midlife adults of the same chronological age have implications for future frailty risk and policy.

Some humans age faster than others. Variation in biological aging can be measured in midlife, but the implications of this variation are poorly understood. We tested associations between midlife biological aging and indicators of future frailty-risk in the Dunedin cohort of 1037 infants born the same year and followed to age 45. Participants' Pace of Aging was quantified by tracking declining function in 19 biomarkers indexing the cardiovascular, metabolic, renal, immune, dental, and pulmonary systems across ages 26, 32, 38, and 45 years. At age 45 in 2019, participants with faster Pace of Aging had more cognitive difficulties, signs of advanced brain aging, diminished sensory-motor functions, older appearance, and more pessimistic perceptions of aging. People who are aging more rapidly than same-age peers in midlife may prematurely need supports to sustain independence that are usually reserved for older adults. Chronological age does not adequately identify need for such supports.

The burden of infertility in New Zealand: A baseline survey of prevalence and service use.

BACKGROUND: Studies in southern New Zealand indicate that up to a quarter of women experienced infertility, likely due to delay in childbearing. However, these findings may not be generalisable to the whole population. AIMS: To assess the lifetime prevalence of infertility and evidence for disparities for New Zealand men and women in a nationally representative sample. MATERIALS AND METHODS: In 2014/15 a general health survey with a module on sexual and reproductive health was conducted among New Zealand residents aged 16-74 years; 3792 men and 5222 women provided information on infertility. RESULT(S): There were 8.2% (95% CI 7.1-9.4%) of men and 12.5% (11.3-13.8%) of women who had experienced infertility; among fertility-tested women this was 15.4% (14.0-16.9%). Prevalence peaked in the 35-44 year age group (14.3% for men, 19.1% for women and 20.8% for fertility-tested women). Estimates for European, Maori and Asian ethnicities were similar. Pacific men and women had higher relative risks: 2.37 (95% CI 1.51-3.71) and 1.76 (1.27-2.44), respectively, compared with Europeans. Medical help was sought by 69.3% (95% CI 62.4-75.5%) of infertile men and 68.2% (63.1-72.9%) of women; this was significantly lower for Maori and Pacific. CONCLUSIONS: Infertility levels for those of European ethnicity were similar to studies in southern New Zealand, and in other high-income countries. However, infertility levels were just as high for Maori, and higher for Pacific people, despite experiencing fertility at younger ages. Focusing on reducing causes of infertility other than delayed childbearing would likely contribute to addressing this health disparity.

Chlamydia Testing in New Zealand: Analysis of the 2014/2015 National Health Survey.

BACKGROUND: Diagnosis rates of Chlamydia trachomatis are high in New Zealand; 1.3% of men and 3.7% of women aged 15 to 29 years were diagnosed in 2016. Because testing rates are also higher in women, we sought to understand chlamydia testing by demographic and behavioral characteristics. METHODS: Chlamydia testing in the past year, sexual behavior, and demographic characteristics were reported in the population-based 2014/2015 New Zealand Health Survey. Those aged 16 to 44 years who had a sexual partner in the past year were included. Testing prevalence was calculated, and associations were modeled. RESULTS: A total of 1677 men and 2323 women participated (89% response rate). Of these, 5.6% (95% confidence interval, 4.3%-7.2%) of men and 16.6% (14.7%-18.7%) of women were tested in the past year. Likelihood of testing in men was associated with having multiple partners and any condomless sex (adjusted relative risk, 11.93; 95% confidence interval, 5.70-24.98) and multiple partners with consistent condom use (3.77, 1.40-10.15) compared with one sexual partner and consistent condom use, and with Maori ethnicity (1.87, 1.05-3.31) compared with European/other. Among women, testing was associated with multiple partners with and without condomless sex (3.61 [2.69-4.85] and 2.81 [1.95-4.05], respectively), pregnancy (1.61, 1.18-2.18), and Asian ethnicity (0.52, 0.30-0.89). CONCLUSIONS: The study confirms that New Zealand men are much less likely to be tested than women, a potential reason for ongoing high chlamydia incidence among both sexes. The high testing rate in women includes many at low risk, and this divergence from recommendations is another issue to address.

Evaluation of a PGP3 ELISA for surveillance of the burden of Chlamydia infection in women from Australia and Samoa.

Serological assays can be used to investigate the population burden of infection and potentially sequelae from Chlamydia. We investigated the PGP3 ELISA as a sero-epidemiological tool for infection or sub-fertility in Australian and Samoan women. The PGP3 ELISA absorbance levels were compared between groups of women with infertility, fertile, and current chlamydial infections. In the Australian groups, women with chlamydial tubal factor infertility had significantly higher absorbance levels in the PGP3 ELISA compared to fertile women (P < 0.0001), but not when compared to women with current chlamydial infection (P = 0.44). In the Samoan study, where the prevalence of chlamydial infections is much higher there were significant differences in the PGP3 ELISA absorbance levels between chlamydial sub-fertile women and fertile women (P = 0.003). There was no difference between chlamydial sub-fertile women and women with a current infection (P = 0.829). The results support that the PGP3 assay is effective for sero-epidemiological analysis of burden of infection, but not for evaluation of chlamydial pathological sequelae such as infertility.

Ovulation monitoring and fertility knowledge: Their relationship to fertility experience in a cross-sectional study.

BACKGROUND: Various aspects of fertility knowledge, including the timing of the fertile window, have consistently been found to be poor. Limited evidence also suggests ovulation monitoring to time intercourse could be common. However, there have been no studies that compare these two aspects of fertility and women's fertility/infertility experiences. AIM: To examine the frequency of ovulation monitoring and its relationship with fertility knowledge and experience. METHOD: A cross-sectional study of women aged 25-50 years resident in southern New Zealand was undertaken in 2011. Randomly selected women were asked to complete a fertility questionnaire. Outcome prevalence measures were calculated with 95% confidence intervals (CI) and associations investigated using χ2 tests and Poisson regression. RESULTS: Ovulation monitoring was common, having ever been undertaken by 31.4% (95% CI: 28.5-34.3%) of the 1034 participants. However, knowledge was poor, particularly regarding the fertile window. More women who had ever monitored ovulation correctly identified the fertile window, although the proportion was still very low (18.4 vs 13.1% in those who had not, P = 0.027). Regression modelling showed ovulation monitoring was independently associated with seeking medical help to conceive, education and fertility experience, but not with knowledge. CONCLUSION: This study confirms ovulation monitoring was commonly undertaken. However, many women, including those who had monitored their ovulation, had poor fertility knowledge and failed to identify the fertile window. Poor fertility knowledge needs to be addressed, especially among women intending to conceive.

Chlamydia trachomatis Pgp3 Antibody Persists and Correlates with Self-Reported Infection and Behavioural Risks in a Blinded Cohort Study.

Chlamydia trachomatis (Ct) serological studies in populations could help monitor changes in lifetime cumulative risk of infection. We developed a double-antigen sandwich ELISA based on the Ct-specific Pgp3 antigen, then tested blind stored sera from over 800 participants in a New Zealand birth cohort from Dunedin at ages 26, 32 and 38. The double-antigen sandwich ELISA was more sensitive than our previously characterised indirect Pgp3 ELISA. Pgp3 antibody was detected more often in women compared to men and correlated with increasing numbers of sexual partners, self-reported Ct, and younger age at sexual debut in both women and men. At age 26, 24.1% (99/411) of women were Pgp3 seropositive, as were 79.5% (35/44) of those reporting Ct infection; Pgp3 antibody persisted to age 38 in 96.5% (83/86). In men at age 26, the figures were 10.7% (47/442) and 25.0% (6/24), respectively, with high (83.9%) antibody persistence to age 38. At age 38, among those Pgp3 seropositive, 63.3% of women and 83.1% of men had not reported Ct infection. Thus, Ct-specific Pgp3 antibody was detected in most women reporting Ct infection and correlated with risk of infection in those who did not, with most infections remaining undetected. As this antibody persisted for at least twelve years in 96% of these women, serology could be used to evaluate Ct prevention programmes among women.

Do Reports of Age and Circumstances of First Intercourse Differ in a Birth Cohort When Asked Seventeen Years Apart?

Conclusions about temporal changes in age and circumstances of first intercourse are generally derived from retrospective reports by people of various ages in cross-sectional studies, with an inherent assumption of no bias stemming from time since the event. We examined this assumption through repeated questions on age and circumstances of first heterosexual intercourse (FHI) at ages 21 and 38 in a birth cohort. Despite considerable movement in individual reports, there was no bias in reported age of FHI. However, a greater proportion of both men and women stated at the later assessment both partners had been equally willing (versus persuading or persuaded). The distribution of current views of the appropriateness of the timing did not differ markedly between assessments, although there were many individual changes. Reports of contraceptive usage were similar at the two assessments for men but differed among women, mainly through more reporting that they could not remember. These findings imply that among cohorts born in the 1970s, there is no bias in reports of age of FHI many years after the event, and views on the appropriateness of timing persist. However, time biases reports in favor of a more mutual willingness.

Prevalence of Chlamydia trachomatis infection in Samoan women aged 18 to 29 and assessment of possible risk factors: a community-based study.

BACKGROUND: Knowledge about genital Chlamydia trachomatis (CT) infections in the Pacific is limited. In this study we investigated CT infection in Samoan women. METHODS: We recruited women having unprotected sex aged 18 to 29 years from 41 Samoan villages. They completed a questionnaire and provided a urine sample for CT testing by PCR. Associations between CT infection and possible risk factors were explored using logistic regression. RESULTS: Altogether, 239 women were recruited; 86 (36.0%; weighted estimate of prevalence: 41.9%; 95% CI: 33.4-50.5%) were positive for CT infection. A higher proportion of women aged 18 to 24 were positive (54/145; 37.2%) than those aged 25 to 29 (32/94; 34.0%; p=0.20). Being single (OR 1.92; 95% CI: 1.02-3.63) and having two or more lifetime sexual partners (OR 3.02; 95% CI: 1.19-7.67) were associated with CT infection; 27.6% of those with one lifetime partner were positive. Participants who had a previous pregnancy were less likely to be positive (OR 0.49; 95% CI: 0.27-0.87). Primiparous and multiparous women were less likely to be positive than nulliparous women (OR 0.54; 95% CI: 0.30-0.99 and OR 0.46; 95% CI: 0.24-0.89, respectively). CONCLUSIONS: The prevalence of CT infection in these Samoan women is very high. Further studies, including investigating the prevalence of CT infection in men, and strategies for sustainable control are needed.

Infertility and outcomes for infertile women in Otago and Southland.

AIM: To establish the burden of infertility in women residing in Otago and Southland. METHODS: A survey of women aged 25-50 years residing in Otago and Southland was conducted to determine the proportions that experienced infertility, sought medical help and resolved their infertility, and to assess the determinants of these outcomes. RESULTS: Of the 1,125 participants, 21.7% (95% CI 19.1-24.4%) had experienced infertility, defined as ever having tried unsuccessfully to conceive for at least 12 months, increasing to 25.3% (22.6-28.1%) when seeking medical help was included in this measure. Seeking medical help to conceive among those having difficulties was very common and most women resolved their first episode of infertility with a live birth. Infertility was more common with extremes of body mass index, higher education and not being in a heterosexual relationship. Infertility resolution was less likely for those over 35 years at onset of infertility and with increasing social deprivation. DISCUSSION: Infertility was common in women residing in Otago and Southland. Despite high levels of infertility resolution overall, those with higher deprivation appeared disadvantaged. Further research is needed to provide national estimates and investigate factors influencing infertility outcomes.

HSV-2 incidence by sex over four age periods to age 38 in a birth cohort.

OBJECTIVES: To examine herpes simplex virus type 2 (HSV-2) incidence over four periods to age 38 in a birth cohort, and to compare risks for men and women, taking into account sexual behaviour. METHODS: At ages 21, 26, 32 and 38, participants in the Dunedin Multidisciplinary Health and Development Study were invited to provide serum for HSV-2 serology, and information on sexual behaviour. HSV-2 incidence rates were calculated for four age periods, and comparisons made by sex and period, taking into account number of sexual partners. RESULTS: By age 38, 17.3% of men and 26.8% of women had ever been seropositive for HSV-2. Incidence peaked for women from age 21 to 26 (19.1 per 1000 person-years) and men from age 26 to 32 (14.1 per 1000 person-years); it fell markedly for both from age 32 to 38 (5.1 and 6.8 per 1000 person-years for men and women, respectively). Overall risk was significantly higher for women: adjusted incidence rate ratio 1.9 (95% CI 1.4 to 2.7); the sex difference was most marked from age 21 to 26 (3.4, 95% CI 1.9 to 6.3). CONCLUSIONS: Our findings are consistent with a greater biological susceptibility to HSV-2 among women, and with the increasing risk to the early/mid-20s for women and late 20s/early 30s for men, being driven by an increasing pool of prevalent infection. The reduced risk in the mid-30s is consistent with declining infectivity of long-term prevalent infections.

Strengthening health research capacity from within Samoa.

This article reflects on the challenges of strengthening health research capacity from within Samoa. It examines the status of health research and related curricula in Samoa and discusses the outcomes of a new postgraduate applied social and health research methods course taught in Samoa for the first time from 5 January to 12 February 2010 by the Department of Preventive and Social Medicine, University of Otago in collaboration with the Centre for Samoan Studies, National University of Samoa. The article argues that collaborative health research courses such as this methods paper can fill a curriculum gap in New Zealand and Samoa and contribute directly toward strengthening Samoa health research capacity in ways that benefit both Samoa and New Zealand. This initiative can be a flagship for strategies operating from within Samoa that can build real win-win type partnerships. These can be ably led by Samoans for the ultimate development of an affordable and sustainable quality health and education infrastructure for Samoa.