Mary A. Ott

Permanent URI for this collection

https://hdl.handle.net/1805/11716

Developmental & Relationship Contexts of Adolescent Sexual Behavior and Sexually Transmitted Infections

Mary Ott’s research examines adolescent health and development with a focus on sexual behavior, unintended pregnancy and sexually transmitted infections (STIs).

Dr. Ott started with a rigorous scientific examination of sexual abstinence as a health decision. Abstinence had become a highly politicized primary approach to reducing adolescent pregnancy, yet our scientific understanding of how adolescents made decisions about abstinence was limited. Dr. Ott’s interdisciplinary research program advances our understanding of how development, relationships and social contexts influence adolescent abstinence decisions. Four linked studies use a mix of qualitative and quantitative research methods that are drawn from psychology, sociology, anthropology, and medicine. Her research findings have been translated into practice on several levels: (1) a developmental framework for office-based counseling; (2) evaluation and improvement of Indiana RESPECT, an abstinence-focused public health education program; and (3) research findings have been directly incorporated into Society for Adolescent Medicine policy statements.

Dr. Ott’s current research is a developmental examination of how adolescent boys’ make decisions about romantic and sexual relationships, and the impact of those decisions on STIs. Results suggest important roles for families in STI prevention, and identify patterns of communication that can inform both office-based STD prevention counseling and STD prevention programs.

She has provided technical assistance and consultation in adolescent health for several community organizations. For example, focus groups with Indiana youth across the state on their health related priorities provided important youth input to the Indiana Coalition to Improve Adolescent Health for the first Indiana state health plan for adolescents.

Professor Ott’s long-term goal is to inform and improve interventions that promote healthy sexual development and prevent adolescent unintended pregnancy and STIs.

Dr. Ott’s contributions to better understanding adolescent health and decision-making is an example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.

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Now showing 1 - 10 of 48

Abstinence and abstinence-only education
(Lippincott, Williams & Wilkins, 2007-10) Ott, Mary A.; Santelli, John S.; Pediatrics, School of Medicine
PURPOSE OF REVIEW: To review recent literature on medical accuracy, program effectiveness, and ethical concerns related to abstinence-only policies for adolescent sexuality education. RECENT FINDINGS: The federal government invests over 175 million dollars annually in 'abstinence-only-until-marriage' programs. These programs are required to withhold information on contraception and condom use, except for information on failure rates. Abstinence-only curricula have been found to contain scientifically inaccurate information, distorting data on topics such as condom efficacy, and promote gender stereotypes. An independent evaluation of the federal program, several systematic reviews, and cohort data from population-based surveys find little evidence of efficacy and evidence of possible harm. In contrast, comprehensive sexuality education programs have been found to help teens delay initiation of intercourse and reduce sexual risk behaviors. Abstinence-only policies violate the human rights of adolescents because they withhold potentially life-saving information on HIV and other sexually transmitted infections. SUMMARY: Federal support of abstinence-only as an approach to adolescent sexuality education is of much concern due to medical inaccuracies, lack of effectiveness, and the withholding and distorting of health information.
Condoms and developmental contexts in younger adolescent boys
(BMJ Publishing Group, 2010-10) Rosenberger, Joshua G.; Bell, David L.; McBride, Kimberly R.; Fortenberry, J. Dennis; Ott, Mary A.; Pediatrics, School of Medicine
BACKGROUND: Condom use is a key part of sexually transmitted infection (STI) prevention for young men. Yet little is known about how younger adolescent boys initially learn about and use condoms. We examined sources of information, attitudes towards, acquisition, practice and early use of condoms among 14-16-year-old boys. METHODS: Thirty 14-16-year-old boys were recruited from a teen clinic serving a community with high STI rates and were asked open-ended questions about condoms, such as, "Where did you learn about condoms?" and "In what situations would you/would you not, use condoms." Interviews were audio recorded, transcribed and coded. Qualitative analysis focused upon key concepts and shared social cognitions related to condom use. RESULTS: Both sexually inexperienced and experienced participants perceived that sex feels or would feel less pleasurable with condoms. For almost all participants, families were the primary source of both information about condoms and of condoms themselves. This information focused on pregnancy prevention, with STIs secondary. Participants' views of condoms fell into three developmental groups: not interested in condoms and equating their use with interest in sex; exploring condoms out of either curiosity or in preparation for sex; and experienced with condom use. Exploring included behaviours such as checking condoms out and trying them on. CONCLUSIONS: Our findings of existing negative perceptions of condoms, the importance of families in learning about condoms and the developmental need to test and try on condoms before use have implications for adolescent STI prevention programmes.
Longitudinal associations among relationship factors, partner change, and sexually transmitted infection acquisition in adolescent women
(Lippincott, Williams & Wilkins, 2011-03) Ott, Mary A.; Katschke, Adrian; Tu, Wanzhu; Fortenberry, J. Dennis; Pediatrics, School of Medicine
OBJECTIVES: New sex partners put adolescents at increased risk for sexually transmitted infections (STIs), even when these sex partners are nonoverlapping. Although the risk of partner change is well described, little is known about its antecedents. We prospectively examined associations between relationship characteristics, partner change, and subsequent STI during intervals of "serial monogamy." METHODS: As part of a longitudinal study, 332 adolescent women were interviewed and tested for gonorrhea, chlamydia, and trichomonas every 3 months for up to just over 6 years. Interviews covered partner-specific relationship characteristics and sexual behaviors. The quarterly interval, a 3-month period bracketed by interviews and STI testing, was the unit of analysis. We examined associations among relationship factors, partner change, and subsequent STI using a series of mixed regression models, controlling for age, STI at Time 1, and condom nonuse. RESULTS: Age, lower relationship quality, and lower levels of partner closeness to friends and family predicted partner change from Time 1 to Time 2. In turn, partner change was associated with acquisition of a new STI at Time 2. Although relationship factors did not exert a direct effect on STI at Time 2, they improved partner change-STI model fit. Similar patterns were seen with each organism. CONCLUSION: Relationship factors drive partner change, which in turn contributes to STI acquisition. STI prevention research may need to focus on the relationship antecedents to partner change, in addition to the partner change itself.
Premenarchal Girls' Genital Examination Experiences
(Elsevier, 2012-08) Robbins, Cynthia L.; Fortenberry, J. Dennis; Roth, Alexis M.; Ott, Mary A.
Purpose To explore girls' experiences having an external genital examination during early adolescence. Methods Ten premenarchal girls were interviewed about their experiences receiving an external genital examination as part of a larger longitudinal study. Qualitative methods were used for analysis, looking for concepts based on themes and shared beliefs among the girls to create a model of the genital examination experience. Results Most participants could not remember ever having a genital examination before enrollment in the larger study. The examination was best characterized as “weird,” and many aspects of the examination were novel. Overall, genital examinations were not experienced negatively because of moderating factors like having support from mothers during the examination and having examiner preferences toward gender and personal characteristics. With repeated study examinations in the larger study and for those participants who reported their provider performed genital examinations, the examination was viewed as a skill for growing up or routine. Conclusions External genital examinations, although a new experience for many girls, can be experienced positively. Providers should address concerns about this important recommended examination and acknowledge that examiner attributes, mothers, and experience of having examinations all influence how genital examinations are experienced.
Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high-STI prevalence communities
(Elsevier, 2014-05) Cummings, Teresa; Auerswald, Colette L.; Ott, Mary A.; Department of Pediatrics, IU School of Medicine
Purpose Abstinence is a core pregnancy and STI prevention strategy. We explore the attitudinal, behavioral, and family contexts relating to abstinence and the decision to delay sex among adolescent boys. Methods Adolescent boys ages 14–17 were recruited from community sites using a venue-based sampling method. All eligible boys at venues were invited to participate in an electronic survey. Question items included sexual behaviors, attitudes related to sex, relationships, masculine values, and family contextual items. Results We enrolled 667 participants, age 15.7 years, of diverse ethnicity. 252 (38%) were abstinent. Abstinent participants were younger, less likely to report non-coital behaviors, and reported lower conventional masculine values. Among abstinent participants, 62% planned to delay sex, while 38% anticipated sex in the next year. Participants with lower conventional masculine values, and more religious or moral motivations for abstinence were more likely to plan to delay sex. Discussion Abstinence among boys is common, even in high STI risk communities. For these boys, abstinence appears to be a complex behavioral decision, influenced by demographic, behavioral, attitudinal and contextual factors such as age, race, non-coital sexual behaviors and masculine values. Understanding the attitudes and contexts of abstinence, including plans to delay sex, can inform the development of public health programs for early fatherhood and STI prevention.
Teen Pregnancy and Confidentiality
(American Medical Association, 2014-11) Ott, Mary A.; Department of Pediatrics, IU School of Medicine
Adolescent decision making about participation in a hypothetical HIV vaccine trial
(Elsevier, 2015-03-10) Alexander, Andreia B.; Ott, Mary A.; Lally, Michelle A.; Sniecinski, Kevin; Baker, Alyne; Zimet, Gregory D.; Department of Pediatrics, IU School of Medicine
Purpose The purpose of this study was to examine the process of adolescent decision-making about participation in an HIV vaccine clinical trial, comparing it to adult models of informed consent with attention to developmental differences. Methods As part of a larger study of preventive misconception in adolescent HIV vaccine trials, we interviewed 33 male and female 16–19-year-olds who have sex with men. Participants underwent a simulated HIV vaccine trial consent process, and then completed a semistructured interview about their decision making process when deciding whether or not to enroll in and HIV vaccine trial. An ethnographic content analysis approach was utilized. Results Twelve concepts related to adolescents' decision-making about participation in an HIV vaccine trial were identified and mapped onto Appelbaum and Grisso's four components of decision making capacity including understanding of vaccines and how they work, the purpose of the study, trial procedures, and perceived trial risks and benefits, an appreciation of their own situation, the discussion and weighing of risks and benefits, discussing the need to consult with others about participation, motivations for participation, and their choice to participate. Conclusion The results of this study suggest that most adolescents at high risk for HIV demonstrate the key abilities needed to make meaningful decisions about HIV vaccine clinical trial participation.
Masculinity in Adolescent Males’ Early Romantic and Sexual Heterosexual Relationships
(Sage, 2015-05) Bell, David L.; Rosenberger, Joshua G.; Ott, Mary A.; Department of Pediatrics, IU School of Medicine
There is a need to understand better the complex interrelationship between the adoption of masculinity during adolescence and the development of early romantic and sexual relationships. The purpose of this study was to describe features of adolescent masculinity and how it is expressed in the contexts of early to middle adolescent males’ romantic and sexual relationships. Thirty-three 14- to 16-year-old males were recruited from an adolescent clinic serving a community with high sexually transmitted infection rates and were asked open-ended questions about their relationships—how they developed, progressed, and ended. Participants described a high degree of relationally oriented beliefs and behaviors related to romantic and sexual relationships, such as a desire for intimacy and trust. The males also described a more limited degree of conventionally masculine beliefs and behaviors. These beliefs and behaviors often coexisted or overlapped. Implications for the clinical care of similar groups of adolescents are described.
Coping with physical and psychological symptoms: a qualitative study of advanced lung cancer patients and their family caregivers
(Springer-Verlag, 2015-07) Mosher, Catherine E.; Ott, Mary A.; Hanna, Nasser; Jalal, Shadia I.; Champion, Victoria L.; Department of Psychology, School of Science
PURPOSE: Advanced lung cancer patients have high rates of multiple physical and psychological symptoms, and many of their family caregivers experience significant distress. However, little is known about strategies that these patients and their family caregivers employ to cope with physical and psychological symptoms. This study aimed to identify strategies for coping with various physical and psychological symptoms among advanced, symptomatic lung cancer patients and their primary family caregivers. METHODS: Patients identified their primary family caregiver. Individual semi-structured qualitative interviews were conducted with 21 advanced, symptomatic lung cancer patients and primary family caregivers. Thematic analysis of interview data was framed by stress and coping theory. RESULTS: Patients and caregivers reported maintaining a normal routine and turning to family and friends for support with symptom management, which often varied in its effectiveness. Whereas support from health-care professionals and complementary and alternative medicine were viewed favorably, reactions to Internet and in-person support groups were mixed due to the tragic nature of participants' stories. Several cognitive coping strategies were frequently reported (i.e., changing expectations, maintaining positivity, and avoiding illness-related thoughts) as well as religious coping strategies. CONCLUSIONS: Results suggest that advanced lung cancer patients and caregivers may be more receptive to cognitive and religious approaches to symptom management and less receptive to peer support. Interventions should address the perceived effectiveness of support from family and friends.
Adapting ethical guidelines for adolescent health research to street-connected children and youth in low- and middle-income countries: a case study from western Kenya
(Springer (Biomed Central Ltd.), 2015-12-18) Embleton, L.; Ott, Mary A.; Wachira, J.; Naanyu, V.; Kamanda, A.; Makori, D.; Ayuku, D.; Braitstein, P.; Department of Epidemiology, Richard M. Fairbanks School of Public Health
BACKGROUND: Street-connected children and youth (SCCY) in low- and middle-income countries (LMIC) have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY's specific vulnerabilities in LMIC. METHODS: As part of three interrelated research projects in western Kenya, we created procedures to address SCCY's vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report. RESULTS: Substantial community engagement provided input on SCCY's participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation. CONCLUSIONS: Although a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity.

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