Browsing by Author "Rosenberg, Molly"
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Item 80. Disparities in Perceived Vulnerability to COVID-19 Consequences Among U.S. Adolescents and Young Adults: Findings from a Nationally Representative Survey(Elsevier, 2021-02) Hensel, Devon J.; Rosenberg, Molly; Luetke, Maya; Herbenick, Debby; Pediatrics, School of MedicinePurpose: Global research has documented the adverse impact of COVID-19 on the health and well-being of adolescents and young adults (AYA). Pandemic conditions can increase AYA vulnerability to COVID-19-related health (e.g. getting sick or missing medical appointments), social (e.g. not having enough to eat) and economic (e.g. job loss) consequences. Structural inequalities may further exacerbate exposure to these outcomes. We used nationally representative data to examine AYA perceived vulnerability to health/social outcomes early in the COVID-19 pandemic. Methods: Data were the 2020 National Survey of Sexual and Reproductive Health during COVID-19 (Ipsos Research: Menlo Park, CA, USA), an online, nationally representative survey of COVID-19 experiences and knowledge among noninstitutionalized adults in the United States (all 50 states and District of Columbia). Of all individuals recruited (N=1632; 18-94 years), 1010 (62%) completed the survey. We retained a subsample of participants 18-25 years of age (N=106; 10.1% of the larger study) for our current analytic sample. Participants rated the next 12-week occurrence likelihood of eight COVID consequences (all dichotomized for analsis: no chance + low chance – 25% vs. medium chance – 25% to 75% + high chance - >75%). Illness consequences were: being exposed to COVID-19, getting an infection from COVID-19, being hospitalized from COVID-19, knowing someone with COVID-19, knowing someone who has died from COVID-19. Social/economic consequences were: losing job, partner/spouse losing job, not having enough to eat, parent(s) losing their job, missing important healthcare appointments/treatments. Structural variables were: gender (male/female), age (18-21/22-25), sexual identity (heterosexual/sexual minority [SM]) and race/ethnicity (White/BIPOC). We evaluated the prevalence heterogeneity across structural variables using nonparametric McNemar tests. All estimates were adjusted using Ipsos provided weights to account for sampling differences and/or nonresponse. Results: The majority of AYA in the United States (85%) believed they were vulnerable to 2+ health or social/economic consequences. Significantly more SM (36.4%-57.5%) than heterosexual (23.2%-37.0%; p<.001 both) AYA perceived vulnerability to being exposed to and/or getting an infection from COVID-19. A significantly greater number of BIPOC (16.2%-38.7%) than White (11.4%-18.8%; p<.001 both) believed they were vulnerable to COVID19-associated hospitalization or job loss. More SM (26.4%) than heterosexual (22.4%; p<.001) AYA estimated a medium-to high likelihood they would know someone who died of COVID-19. Significantly more BIPOC than White AYA felt high vulnerability to personal job loss (38.7% vs. 18.8%; p=.015), parent job loss (19.0% vs. 16.3%; p<.001) and not having enough to eat (16.3% vs. 10.0%; p<.001). Conclusions: Nationally, many AYA – particularly sexual minority and BIOPC youth – believe they are highly vulnerability to COVID-19 associated consequences. Professionals who work with youth may consider including screening for COVID-19 worries during clinical/educational interactions as a means of both understanding and normalizing AYA’s experiences, as well as helping them devise support or coping mechanisms, during this unprecedented time. These “check-ins” may be particularly where long-term worry about COVID-19 could exacerbate existing disparities in mental and physical health among marginalized AYA.Item 80. Disparities in Perceived Vulnerability to COVID-19 Consequences Among U.S. Adolescents and Young Adults: Findings from a Nationally Representative Survey(Elsevier, 2021-02) Hensel, Devon J.; Rosenberg, Molly; Luetke, Maya; Herbenick, Debby; Pediatrics, School of MedicineGlobal research has documented the adverse impact of COVID-19 on the health and well-being of adolescents and young adults (AYA). Pandemic conditions can increase AYA vulnerability to COVID-19-related health (e.g. getting sick or missing medical appointments), social (e.g. not having enough to eat) and economic (e.g. job loss) consequences. Structural inequalities may further exacerbate exposure to these outcomes. We used nationally representative data to examine AYA perceived vulnerability to health/social outcomes early in the COVID-19 pandemic.Item Changes in Penile-Vaginal Intercourse Frequency and Sexual Repertoire from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior(Springer, 2021-11) Herbenick, Debby; Rosenberg, Molly; Golzarri-Arroyo, Lilian; Fortenberry, J. Dennis; Fu, Tsung-chieh; Medicine, School of MedicineSolo and partnered sexual behaviors are relevant to health, well-being, and relationships. Recent research shows that sexual frequency has declined in the U.S. and in other countries; however, measurement has been imprecise. We used data from 14- to 49-year-old participants in the 2009 and 2018 waves of the National Survey of Sexual Health and Behavior (NSSHB), a confidential U.S. nationally representative survey that is conducted online. We aimed to: (1) assess changes in frequency of past-year penile-vaginal intercourse and (2) examine combinations of past-year sexual behaviors for each of the two waves. We hypothesized that we would observe lower frequency of penile-vaginal intercourse (PVI) from 2009 to 2018 and that we would observe greater engagement in sexual repertoires involving non-coital partnered behaviors (e.g., partnered masturbation, oral sex) in 2018 as compared to 2009. Participants were 4155 individuals from the 2009 NSSHB (Adolescents: 406 females, 414 males; Adults: 1591 women, 1744 men) and 4547 individuals from the 2018 NSSHB (Adolescents: 416 females, 411 males; Adults: 2007 women, 1713 men). Compared to adult participants in the 2009 NSSHB, adults in the 2018 NSSHB were significantly more likely to report no PVI in the prior year (28% in 2018 vs. 24% in 2009). A similar difference in proportions reporting no PVI in the prior year was observed among 14–17-year-old adolescents (89% in 2018 vs. 79% in 2009). Additionally, for both adolescents and adults, we observed decreases in all modes of partnered sex queried and, for adolescents, decreases in solo masturbation.Item Changes in Solo and Partnered Sexual Behaviors during the COVID-19 Pandemic: Findings from a U.S. Probability Surve(medRxiv, 2020) Hensel, Devon; Rosenberg, Molly; Luetke, Maya; Fu, Tsung-chieh; Herbenick, DebbyBackground Research demonstrates that pandemics adversely impact sexual and reproductive health (SRH), but few have examined their impact on people’s participation in sex. We examined self-reported changes in solo and sexual behaviors in U.S. adults during early stages of the public health response to COVID-19. Methods We conducted an online, nationally representative, cross-sectional survey of U.S. adults (N=1010; aged 18-94 years; 62% response rate) from April 10-20, 2020. We used weighted multinomial logistic regression to examine past month self-reported changes (decreased, stable or increased) in ten solo and partnered sexual behaviors. Predictor variables included: having children at home, past month depressive symptoms, (ACHA 3-item scale), past month loneliness (UCLA 3-Item Loneliness scale), COVID-19 protection behaviors (adapted 12-item scale), perceived COVID-19 consequences (adapted 10-item scale) and COVID-19 knowledge (adapted 10-item scale). Results Nearly half of all adults reported some kind of change – most commonly, a decrease – in their sexual behavior in the past month. Having elementary aged children at home, past month depressive symptoms and loneliness and enacting more COVID-19 protective behaviors were associated with both reduced partnered bonding behaviors, such as hugging, cuddling, holding hands and kissing, as well as reduced partnered sexual behaviors, such as oral sex, partnered genital touching and vaginal sex. Greater COVID-19 risk perception and greater COVID-19 knowledge were associated with mixed effects in behavior outcomes. Conclusions Our data illustrate the very personal ways in which different pandemic-associated factors may create or inhibit opportunities for solo and partnered sex. The centrality of sexuality to health and well-being – even during pandemics – means that a critical piece of public health prevention and management responses should is ensuring that services and resource that support positive sexual decision making remain open and available.Item Depression and loneliness during April 2020 COVID-19 restrictions in the United States, and their associations with frequency of social and sexual connections(Springer, 2021-01) Rosenberg, Molly; Luetke, Maya; Hensel, Devon J.; Kianersi, Sina; Fu, Tsung-chieh; Herbenick, Debby; Pediatrics, School of MedicinePurpose: To estimate the prevalence of depression and loneliness during the US COVID-19 response, and examine their associations with frequency of social and sexual connections. Methods: We conducted an online cross-sectional survey of a nationally representative sample of American adults (n = 1010), aged 18–94, running from April 10–20, 2020. We assessed depressive symptoms (CES-D-10 scale), loneliness (UCLA 3-Item Loneliness scale), and frequency of in-person and remote social connections (4 items, e.g., hugging family member, video chats) and sexual connections (4 items, e.g., partnered sexual activity, dating app use). Results: One-third of participants (32%) reported depressive symptoms, and loneliness was high [mean (SD): 4.4 (1.7)]. Those with depressive symptoms were more likely to be women, aged 20–29, unmarried, and low-income. Very frequent in-person connections were generally associated with lower depression and loneliness; frequent remote connections were not. Conclusions: Depression and loneliness were elevated during the early US COVID-19 response. Those who maintained very frequent in-person, but not remote, social and sexual connections had better mental health outcomes. While COVID-19 social restrictions remain necessary, it will be critical to expand mental health services to serve those most at-risk and identify effective ways of maintaining social and sexual connections from a distance.Item Microfinance, retention in care, and mortality among patients enrolled in HIV 2 Care in East Africa(Wolters Kluwer, 2021-10) Genberg, Becky L.; Wilson-Barthes, Marta G.; Omodi, Victor; Hogan, Joseph W.; Steingrimsson, Jon; Wachira, Juddy; Pastakia, Sonak; Tran, Dan N.; Kiragu, Zana W.; Ruhl, Laura J.; Rosenberg, Molly; Kimaiyo, Sylvester; Galárraga, Omar; Medicine, School of MedicineObjective: To measure associations between participation in community-based microfinance groups, retention in HIV care, and death among people with HIV (PWH) in low-resource settings. Design and methods: We prospectively analyzed data from 3609 patients enrolled in an HIV care program in western Kenya. HIV patients who were eligible and chose to participate in a Group Integrated Savings for Health Empowerment (GISHE) microfinance group were matched 1 : 2 on age, sex, year of enrollment in HIV care, and location of initial HIV clinic visit to patients not participating in GISHE. Follow-up data were abstracted from medical records from January 2018 through February 2020. Logistic regression analysis examined associations between GISHE participation and two outcomes: retention in HIV care (i.e. >1 HIV care visit attended within 6 months prior to the end of follow-up) and death. Socioeconomic factors associated with HIV outcomes were included in adjusted models. Results: The study population was majority women (78.3%) with a median age of 37.4 years. Microfinance group participants were more likely to be retained in care relative to HIV patients not participating in a microfinance group [adjusted odds ratio (aOR) = 1.31, 95% confidence interval (CI) 1.01–1.71; P = 0.046]. Participation in group microfinance was associated with a reduced odds of death during the follow-up period (aOR = 0.57, 95% CI 0.28–1.09; P = 0.105). Conclusion: Participation in group-based microfinance appears to be associated with better HIV treatment outcomes. A randomized trial is needed to assess whether microfinance groups can improve clinical and socioeconomic outcomes among PWH in similar settings.Item Relationships between Penile-Vaginal Intercourse Frequency and Condom/Contraceptive Use from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior(Taylor & Francis, 2022) Fu, Tsung-Chieh; Rosenberg, Molly; Golzarri-Arroyo, Lilian; Fortenberry, J. Dennis; Herbenick, Debby; Pediatrics, School of MedicineObjectives: To examine changes over time in event-level condom/contraceptive use and the association between past year penile-vaginal intercourse frequency and event-level condom/contraceptive use. Methods: Data were from the 2009 and 2018 National Survey of Sexual Health and Behavior, an online probability survey of U.S. adolescents and adults. Results: Use of condoms and highly effective hormonal contraceptives decreased while long-acting reversible contraceptive use increased from 2009 to 2018 among adults. Increased penile-vaginal intercourse frequency was associated with decreased use of most contraceptive methods but an increase in condom use for adolescents. Conclusions: Sexual frequency should be considered when assessing condom/contraceptive use.Item SARS-CoV-2 reinfections in a US university setting, Fall 2020 to Spring 2021(BMC, 2022-07-04) Rosenberg, Molly; Chen, Chen; Golzarri‑Arroyo, Lilian; Carroll, Aaron; Menachemi, Nir; Ludema, Christina; Health Policy and Management, School of Public HealthBackground: SARS-CoV-2 reinfections are a public health concern because of the potential for transmission and clinical disease, and because of our limited understanding of whether and how well an infection confers protection against subsequent infections. Despite the public health importance, few studies have reported rigorous estimates of reinfection risk. Methods: Leveraging Indiana University's comprehensive testing program to identify both asymptomatic and symptomatic SARS-CoV-2 cases, we estimated the incidence of SARS-CoV-2 reinfection among students, faculty, and staff across the 2020-2021 academic year. We contextualized the reinfection data with information on key covariates: age, sex, Greek organization membership, student vs faculty/staff affiliation, and testing type. Results: Among 12,272 people with primary infections, we found a low level of SARS-CoV-2 reinfections (0.6%; 0.4 per 10,000 person-days). We observed higher risk for SARS-CoV-2 reinfections in Greek-affiliated students. Conclusions: We found evidence for low levels of SARS-CoV-2 reinfection in a large multi-campus university population during a time-period prior to widespread COVID-19 vaccination.Item Structural brain morphology in young adult women who have been choked/strangled during sex: A whole‐brain surface morphometry study(Wiley, 2023) Hou, Jiancheng; Huibregtse, Megan E.; Alexander, Isabella L.; Klemsz, Lillian M.; Fu, Tsung-Chieh; Rosenberg, Molly; Fortenberry, James Dennis; Herbenick, Debby; Kawata, Keisuke; Pediatrics, School of MedicineIntroduction: Being choked/strangled during partnered sex is an emerging sexual behavior, particularly prevalent among young adult women. Using a multiparameter morphometric imaging approach, we aimed to characterize neuroanatomical differences between young adult women (18-30 years old) who were exposed to frequent sexual choking and their choking naïve controls. Methods: This cross-sectional study consisted of two groups (choking [≥4 times in the past 30 days] vs. choking-naïve group). Participants who reported being choked four or more times during sex in the past 30 days were enrolled in the choking group, whereas those without were assigned to the choking naïve group. High-resolution anatomical magnetic resonance imaging (MRI) data were analyzed using both volumetric features (cortical thickness) and geometric features (fractal dimensionality, gyrification, sulcal depth). Results: Forty-one participants (choking n = 20; choking-naïve n = 21) contributed to the final analysis. The choking group showed significantly increased cortical thickness across multiple regions (e.g., fusiform, lateral occipital, lingual gyri) compared to the choking-naïve group. Widespread reductions of the gyrification were observed in the choking group as opposed to the choking-naïve group. However, there was no group difference in sulcal depth. The fractal dimensionality showed bi-directional results, where the choking group exhibited increased dimensionality in areas including the postcentral gyrus, insula, and fusiform, whereas decreased dimensionality was observed in the bilateral superior frontal gyrus and pericalcarine cortex. Conclusion: These data in cortical morphology suggest that sexual choking events may be associated with neuroanatomical alteration. A longitudinal study with multimodal assessment is needed to better understand the temporal ordering of sexual choking and neurological outcomes.Item The Impact of Household Context on Self-Perceived Changes in Solo and Partnered Sexual Behaviors During the COVID-19 Pandemic: Findings from a U.S. Probability Survey(Springer, 2023) Hensel, Devon J.; Rosenberg, Molly; Luetke, Maya; Fu, Tsung‑chieh; Herbenick, Debby; Pediatrics, School of MedicineTo understand how household context factors impacted self-reported changes in solo and sexual behaviors in U.S. adults during early stages of the COVID- 19 pandemic, we conducted an online, nationally representative, cross-sectional survey of U.S. adults (N = 1010; aged 18–94 years; 62% response rate) from April 10–20, 2020. We used weighted descriptive statistics with Wilcoxon rank sign tests to understand the population prevalence and significance of self-reported changes (five-point scale: much less to much more) in 10 solo and partnered sexual behaviors. Ordinal regression was used to assess the impact of household predictor variables–including number of children at home, number of adults in home, partnership status (unpartnered, partnered and not living together, partnered and living together) and employment status (not working, employed not as essential worker, employed as essential worker). All models were adjusted for gender, age, sexual orientation, race/ethnicity, and residence location (urban, suburban, rural). All solo and partnered sexual behaviors showed some amount of significant change–increased activity for some and decreased for others–for U.S. adults during the pandemic. Not living with a partner was broadly associated with decreased affectionate partnered sexual behaviors; unpartnered adults reported increased sexting. Individuals not employed reported increased oral sex and increased consumption of sexually explicit materials as compared to non-essential workers. Number of children at home and household size were not significantly linked to self-reported behavior change. Ongoing sexual health-focused research should continue to focus on understanding how adults manage opportunities and constraints to their sexual lives in the context of a still-going pandemic. While many aspects of social life look more “normal” (e.g., many people have returned to their in-person offices and children are largely back in school), new and more-infectious strains of COVID-19 have proven that the pandemic may still yet impact daily living. Lessons learned from COVID need to include sexual health planning both for any future strains of COVID, as well as for future public health emergencies.