Devon Hensel

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https://hdl.handle.net/1805/26677

Understanding cravings and triggers in adolescents attending a recovery high school in a COVID-19 era

According to the National Center for Drug Abuse Statistics, in 2018 some 863,000 12 to 17-year olds were diagnosed with substance use disorder (SUD). However, only .3% received the treatment necessary to begin the journey of recovery. As SUD symptoms of cravings and triggers in adolescents interfere with healthy adulthood milestone transition, it is increasingly important to investigate the real-life barriers in this unique pandemic time and beyond.

Dr. Devon Hensel has partnered with Hope Academy Recovery High School (HARHS) since 2017 to explore the integration of occupational therapy (OT) as part of the core high school recovery team. This most recent project aims to amplify the voice of members directly within the community - the adolescent students – by using real time data collection methods known as Ecological Momentary Assessments (EMAs). Dr. Devon Hensel has vast experience in recruiting and retaining large cohorts of participants for clinical and behavioral research and is a leading researcher utilizing EMA as an approach to daily collection of health and behavioral health data.

Such an approach will allow the research team to better comprehend adolescents’ daily lived experience, improve client centered care, and allow for a greater fidelity in capturing the “real life” barriers in SUD. These data will assist in producing interventions that are theory driven and help to lay the necessary groundwork for larger studies to evaluate the effectiveness of function-based interventions in order to establish occupational therapy's distinct role in SUD recovery, ultimately leading to state and national policy change.

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Condom use as a function of new young adult relationship duration
(Office of the Vice Chancellor for Research, 2014-04-11) Harezlak, Jaroslaw; He, Fei; Hensel, Devon J.; Fortenberry, J. Dennis
Objective: To find out how condom use in new relationships changes as a function of time, gender, as well as sexual and relationship satisfaction. Method: Participants in a larger study who reported at least one new partner during the 12-week study interval (N=115; 18-29 yrs; 48% women; 75% African American) completed weekly STI testing and 3x/day electronic diary collection assessing individual and partner-specific affect, daily activities, sexual behavior and condom use. We analyzed event-level condom use percentage and subject-level behavior response effects. Generalized Additive Mixed Models (GAMMs) were used to estimate condom use probability accounting for within-subject and within-nested-partners correlations via random effects. Results: The average initial condom use in the new relationships was 62% for men and 46% for women. The plotted smooth shapes of the estimated condom use probabilities fitted using GAMMs were qualitatively similar for both sexes throughout the study period. The initial high condom use percentage was followed by a sharp decline during the first 1.5 weeks to 19% for men and 14% for women. The condom use rates stabilized at around 6% after 4 weeks in a new relationship. Women who reported high levels of relationship satisfaction exhibited marginally significant negative association with condom use probability (p-value=0.055). Sex satisfaction was not significantly associated with condom use when both the time trends and gender were taken into account. Conclusion: Condom use declines sharply for both males and females during the early stages of new relationships. Men use condoms more frequently than women in the early and middle stages of relationships. Relationship characteristics may also influence lower levels of condom use, especially among women.
Use of Cell Phone Diaries to Understand Risk Contexts of Sexual Events Among Female Sex Workers
(2013-07) Roth, Alexis M.; Hensel, Devon J.; Gunn, Jayleen K.L.; Fortenberry, J. Dennis; Garfein, R; Arno, Janet N.; Wiehe, Sarah E.
Background Data collection using mobile technologies, such as cell phones, allows more frequent and real-time data collection and is less prone to recall bias. We describe the feasibility of using twice daily cell phone diaries to capture contextual features of STI/HIV-risk that could impact disease acquisition among female sex workers (FSW). Methods Women engaging in transactional sex in the prior 90 days were recruited utilising incentivized snowball sampling. Participants completed STI testing and baseline/exit surveys. Over 4-weeks, they completed twice-daily electronic diaries assessing event-level sexual behaviour, condom use, and drug use. Weekly in-person interviews used open-ended questions to explore geographical characteristics of sexual encounter locations as well as acceptability of event-level monitoring. Results 25/26 participants (median age 43.5 years) completed the 4-week study. At baseline, 27% tested positive for a STI. Participants completed 84.5% of 1,518 expected surveys and 95% of 106 expected interviews. Patterns of diary compliance were stable over time. Partnered sexual activity was captured in 21.4% of diaries. At the participant-level, most reported giving oral sex (84.7%) or vaginal sex (96.1%); fewer (19.2%) reported engaging in anal sex. Among women reporting partnered sexual behaviour with any partner type (i.e., new/regular customers, romantic partners), using condoms was reported 39.2%, 45.5% and 83.3% of the time for giving oral sex, vaginal sex, and anal sex respectively. At the event-level, the frequency of giving oral sex, vaginal sex or anal sex did not significantly change over time. Conclusions It is feasible to engage and retain FSW in a technologically-advanced study to characterise risk contexts of sexual events. Adherence to study protocol was high indicating event-level monitoring using cell phone based diaries is acceptable. These data can be utilised to improve our understanding of the individual, relational and environmental factors that influence STI/HIV acquisition among FSW.
Medical student self-efficacy, knowledge and communication in adolescent medicine
(IJME, 2014-08-20) Woods, Jennifer L.; Pasold, Tracie L.; Boateng, Beatrice A.; Hensel, Devon J.; Department of Pediatrics, School of Medicine
Objectives To evaluate student self-efficacy, knowledge and communication with teen issues and learning activities. Methods Data were collected during the 8-week pediatric rotation for third–year medical students at a local children’s hospital. Students completed a self-efficacy instrument at the beginning and end of the rotation; knowledge and communication skills were evaluated during standardized patient cases as part of the objective structured clinical examination. Self-efficacy, knowledge and communication frequencies were described with descriptive statistics; differences between groups were also evaluated utilizing two-sample t-tests. Results Self-efficacy levels of both groups increased by the end of the pediatric rotation, but students in the two-lecture group displayed significantly higher self-efficacy in confidentiality with adolescents (t(35)=-2.543, p=0.02); interviewing adolescents, assessing risk, sexually transmitted infection risk and prevention counseling, contraception counseling were higher with marginal significance. No significant differences were found between groups for communication; assessing sexually transmitted infection risk was marginally significant for knowledge application during the clinical exam. Conclusions Medical student self-efficacy appears to change over time with effects from different learning methods; this higher self-efficacy may increase future comfort and willingness to work with this high-risk, high-needs group throughout a medical career.
Feasibility of Functional Neuroimaging to Understand Adolescent Women’s Sexual Decision Making
(Elsevier, 2015-04) Hensel, Devon J.; Hummer, Tom A.; Acrurio, Lindsay R.; James, Thomas W.; Fortenberry, J. Dennis; Department of Pediatrics, Indiana University School of Medicine
Purpose For young women, new sexual experiences normatively increase after puberty and coincide with extensive changes to brain regions governing self-regulation of risk behavior. These neurodevelopmental changes could leave some young women vulnerable for negative sexual outcomes, including sexually transmitted infection and unintended pregnancy. We evaluated the feasibility of using functional neuroimaging to understand the sexual decision making of adolescent women. Methods Adolescent women (N = 14; 14–15 years) completed enrollment interviews, a neuroimaging task gauging neural activation to appetitive stimuli, and 30 days of prospective diaries following the scan characterizing daily affect and sexual behaviors. Descriptive and inferential statistics assessed the association between imaging and behavioral data. Results Young women were highly compliant with neuroimaging and diary protocol. Neural activity in a cognitive-affective network, including prefrontal and anterior cingulate regions, was significantly greater during low-risk decisions. Compared with other decisions, high-risk sexual decisions elicited greater activity in the anterior cingulate, and low-risk sexual decision elicited greater activity in regions of the visual cortex. Young women's sexual decision ratings were linked to their sexual history characteristics and daily self-reports of sexual emotions and behaviors. Conclusions It is feasible to recruit and retain a cohort of female participants to perform a functional magnetic resonance imaging task focused on making decisions about sex, on the basis of varying levels of hypothetical sexual risk, and to complete longitudinal prospective diaries following this task. Preliminary evidence suggests that risk level differentially impacts brain activity related to sexual decision making in these women, which may be related to past and future sexual behaviors.
Lifetime Lubricant Use among a Nationally Representative Sample of Lesbian- and Bisexual-Identified Women in the United States
(Wiley, 2015-05) Hensel, Devon J.; Schick, Vanessa; Herbenick, Debby; Dodge, Brian; Reece, Michael; Sanders, Stephanie; Fortenberry, J. Dennis; Department of Pediatrics, IU School of Medicine
Introduction The diversity in self-identified lesbian and bisexual women's sexual interactions necessitates better understanding of how and when they integrate personal lubricant into different experiences. However, little is known about lesbian and bisexual women's lifetime lubricant use, particularly at the population level. Aims The aim of this study was to examine the prevalence and characteristics of lubricant use among adult lesbian and bisexual women in the United States. Methods Data were drawn from a subset of lesbian and bisexual participants who participated in the 2012 National Survey of Sexual Health and Behavior, an online questionnaire administered to a nationally representative probability sample of U.S. adults ages 18 and older. Main Outcome Measures We examined socio-demographic characteristics, recent and lifetime lubricant use, lubricant use in associated with specific sexual behaviors and condom use, frequency of use, motivations for use, as well as perception of lubricant when used. Results A majority of lesbian- (60.1%) and bisexual-identified (77.1%) women reported ever using lubricant; 25.7% of lesbian women and 32.7% of bisexual women used it in the last 30 days. Across most age groups, lubricant was commonly used during partnered sexual play, partnered sexual intercourse, or when a vibrator/dildo was used. Lesbian and bisexual women reported using lubricants to increase arousal/sexual pleasure/desire, to make sex more fun, or to increase physical comfort during sex. Conclusions Lubricant use is identified as a part of lesbian and bisexual women's sexual experience across the life span, as a part of both solo and partnered experiences. As part of evolving sexual health assessments, clinicians and health educators may find value in integrating lubricant-focused conversation with their lesbian and bisexual patients and clients, particularly.
Are social organizational factors independently associated with a current bacterial sexually transmitted infection among urban adolescents and young adults?
(Elsevier, 2014-10) Jennings, Jacky M.; Hensel, Devon J.; Tanner, Amanda E.; Reilly, Meredith L.; Ellen, Jonathan M.; Department of Pediatrics, IU School of Medicine
This study explored the relationship between the social organization of neighborhoods including informal social control and social cohesion and a current bacterial sexually transmitted infection (STI) among adolescents and young adults in one U.S. urban setting. Data for the current study were collected from April 2004 to April 2007 in a cross-sectional household study. The target population included English-speaking, sexually-active persons between the ages of 15 and 24 years who resided in 486 neighborhoods. The study sample included 599 participants from 63 neighborhoods. A current bacterial STI was defined as diagnosis of a chlamydia and/or gonorrhea infection at the time of study participation. Participants reported on informal social control (i.e. scale comprised of 9 items) and social cohesion (i.e. scale comprised of 5 items) in their neighborhood. In a series of weighted multilevel logistic regression models stratified by gender, greater informal social control was significantly associated with a decreased odds of a current bacterial STI among females (AOR 0.53, 95% CI 0.34, 0.84) after controlling for individual social support and other factors. The association, while in a similar direction, was not significant for males (AOR 0.73, 95% CI 0.48, 1.12). Social cohesion was not significantly associated with a current bacterial STI among females (OR 0.85, 95% CI 0.61, 1.19) and separately, males (OR 0.98, 95% CI 0.67, 1.44). Greater individual social support was associated with an almost seven-fold increase in the odds of a bacterial STI among males (AOR 6.85, 95% CI 1.99, 23.53), a finding which is in contrast to our hypotheses. The findings suggest that neighborhood social organizational factors such as informal social control have an independent relationship with sexual health among U.S. urban youth. The causality of the relationship remains to be determined.
Developmental Trajectories of Religiosity, Sexual Conservatism and Sexual Behavior among Female Adolescents
(Elsevier B.V., 2013-12) Aalsma, Matthew C.; Woodrome, Stacy E.; Downs, Sarah M.; Hensel, Devon J.; Zimet, Gregory D.; Orr, Don P.; Fortenberry, J. Dennis; Department of Pediatrics, IU School of Medicine
Understanding the role of socio-sexual cognitions and religiosity on adolescent sexual behavior could guide adolescent sexual health efforts. The present study utilized longitudinal data from 328 young women to assess the role of religion and socio-sexual cognitions on sexual behavior accrual (measuring both coital and non-coital sexual behavior). In the final triple conditional trajectory structural equation model, religiosity declined over time and then increased to baseline levels. Additionally, religiosity predicted decreased sexual conservatism and decreased sexual conservatism predicted increased sexual behavior. The final models are indicative of young women's increasing accrual of sexual experience, decreasing sexual conservatism and initial decreasing religiosity. The results of this study suggest that decreased religiosity affects the accrual of sexual experience through decreased sexual conservatism. Effective strategies of sexual health promotion should include an understanding of the complex role of socio-sexual attitudes with religiosity.
The Relationship Between Sexually Coercive Experience Frequency, Coping, Social Support and Sexual and Mental Health in Adult Women
(Office of the Vice Chancellor for Research, 2015-04-17) Muzzey, Allison K.; Hensel, Devon J.
Introduction: Existing literature separately identifies social support and coping methods as mediating influences between sexual coercion and adverse health outcomes, yet few empirical studies actually evaluate their influence in the same model. The objective of this study was to analyze how adult women’s coping methods and social support jointly mediate the impact of sexually coercive experience on sexual and mental health. Methods: Data are drawn from a larger internet-based, cross-sectional survey examining adult men’s and women’s health and life experiences. For the current study, we retained all female participants (N=113). Structural equation modelling (SEM) (Stata, v. 22; all p<.05) analyzed the hypothesized structural relationships between coping (adaptive and maladaptive), social support (subjective and emotional), sexual coercion, sexual health (sexual openness, sexual anxiety, sexual esteem, and sexual entitlement) and mental health (depression, self-esteem, and anxiety). Results: More frequent sexual coercion predicted higher maladaptive coping (β = .364). Higher levels of maladaptive coping were associated with higher levels of depression (β = .199), anxiety (β = .393), sexual anxiety (β = .346), and sexual openness (β = .251). Additionally, higher levels of maladaptive coping were associated with lower self-esteem (β = -.226). Adaptive coping and social support were not associated with sexual coercion. Conclusion: Adult women’s sexually coercive experiences impact sexual and mental health indirectly through maladaptive coping, but not through adaptive coping or any social support. Our data raise the possibility that maladaptive coping could be an important catalyst for poor mental and sexual health outcomes following a sexually coercive experience. From an education and policy perspective, this means that a focus on reducing maladaptive coping methods may increase mental and sexual health and reduce the likelihood of accruing more sexually coercive experiences.
Women’s Individual and Relationship-Level Attitudes and Behaviors Regarding Solo Masturbation and Vibrator Use
(Office of the Vice Chancellor for Research, 2015-04-17) Sherrow, Ashley R.; Hensel, Devon J.
Background: Both public health and developmental literature emphasize the importance of solo masturbation as one component in healthy sexuality, particularly for women. However, few studies have examined how the context of a woman’s sexual/romantic relationship may impact both her attitudes towards and her frequency of solo masturbation, particularly in terms of vibrator use. Better understanding of this context has important implications for sexual health education and intervention efforts. Methods: Data were drawn from a larger internet-based, cross-sectional survey examining adult men’s and women’s health and life experiences. For the current study, we retained all female participants (N=113; Mean Age=29.37 years [SD=9.91]). Outcome measures included solo masturbation and vibrator use attitudes and behaviors; independent variables were perception of partner's knowledge of and comfort with participant’s masturbation and vibrator use, sexual entitlement, and sexual openness. Descriptive statistics and bivariate correlations, were utilized to describe and understand the relationships among variables of interest (SPSS, v.22.0 (all p<.05). Results: Of the 113 participants, 76.0% (n=85) identified as being in some form of established sexual/romantic relationship. 54.7% (n=52) of participants had ever used a vibrator, while 38.9% (n=37) described themselves as current vibrator users. A majority of participants (62.3%, n=66) indicated that they masturbate a few times per month or more, with 50.0% (n=26) of vibratorusers indicating that they use a vibrator almost every time or every time they masturbate. 42.9% (n=39) of participants described themselves as being completely comfortable with their partner’s masturbation habits, and 59.8% (n=52) described their partner as either somewhat or completely comfortable with the participant’s masturbation. 60.5% (n=55) of participants indicated that they felt either somewhat or completely comfortable discussing masturbation with their partner. 85.7% (n=42) of vibrator-users indicated that their partner knew about their vibrator use, and 66.0% (n=33) felt their partner was either somewhat or completely comfortable with their vibrator use. Considering participants both with and without current partners, greater sense of sexual entitlement was associated with more positive attitudes about masturbation and vibrator use (R=0.758), as well as greater frequency of masturbation (R=0.455). Higher frequency of masturbation also correlated with more positive attitudes about masturbation and vibrator use (R=.381) and greater sexual openness (R=.266). Regarding the relationship context, partner knowledge of vibrator use was positively associated with greater frequency of vibrator use for solo masturbation (R=.361). Greater comfort discussing masturbation with a partner was correlated with more positive perception of partner’s comfort with the participant’s masturbation (R=.389), which in turn was positively associated with greater participant comfort with their partner’s masturbation habits (R=.300). Conclusion: Solo masturbation and vibrator use for masturbation are common among adult women, even when they are in established sexual/romantic relationships. Positive perceptions of a partner’s comfort with masturbation and vibrator use, as well as open sexual communication, may contribute to developing a sex-positive relationship environment that is supportive of women’s solo sex activities. Our findings provide potential avenues for revising existing sexual health and therapeutic interventions for women (with or without a partner).
Perspectives of family medicine physicians on the importance of adolescent preventive care: a multivariate analysis
(BioMed Central, 2016) Taylor, Jaime L.; Aalsma, Matthew C.; Gilbert, Amy L.; Hensel, Devon J.; Rickert, Vaughn I.; Department of Pediatrics, IU School of Medicine
BACKGROUND: The study objective was to identify commonalities amongst family medicine physicians who endorse annual adolescent visits. METHODS: A nationally weighted representative on-line survey was used to explore pediatrician (N = 204) and family medicine physicians (N = 221) beliefs and behaviors surrounding adolescent wellness. Our primary outcome was endorsement that adolescents should receive annual preventive care visits. RESULTS: Pediatricians were significantly more likely (p < .01) to endorse annual well visits. Among family medicine physicians, bivariate comparisons were conducted between those who endorsed an annual visit (N = 164) compared to those who did not (N = 57) with significant predictors combined into two multivariate logistic regression models. Model 1 controlled for: patient race, proportion of 13-17 year olds in provider's practice, discussion beliefs scale and discussion behaviors with parents scale. Model 2 controlled for the same first three variables as well as discussion behaviors with adolescents scale. Model 1 showed for each discussion beliefs scale topic selected, family medicine physicians had 1.14 increased odds of endorsing annual visits (p < .001) and had 1.11 greater odds of endorsing annual visits with each one-point increase in discussion behaviors with parents scale (p = .51). Model 2 showed for each discussion beliefs scale topic selected, family medicine physicians had 1.15 increased odds of also endorsing the importance of annual visits (p < .001). CONCLUSIONS: Family medicine physicians that endorse annual visits are significantly more likely to affirm they hold strong beliefs about topics that should be discussed during the annual exam. They also act on these beliefs by talking to parents of teens about these topics. This group appears to focus on quality of care in thought and deed.

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