Callahan1

RosemaryCallahanResearchSeminarProposal

SexualTransmittedDiseaseRiskinAdolescentWomeninUptown

I. THEPROBLEMANDITSSETTING

A. StatementoftheTopictobeExplored

Thethemeofthisresearchproposalis“KnowingNeighborhoods.”ThecitythatIwill

exploreisChicago;itisregardedashighlydiverseandsegregated.Chicagocontains77distinct

communitiesorneighborhoods(“CityofChicagoCommunityAreas”).AccordingtoWalter

NugentfortheEncyclopediaofChicago,“Chicagohaslongbeenknownasanethniccity.”

Startingin1910manyAfricanAmericansmigratedfromthesouthtoChicago.Theywere

followedbyimmigrantsfrommanydifferentcountriesincludingpeoplefromPoland,Ireland,

Germany,Britain,Scandinavia,Czechoslovakia,Lithuania,Serbia,Croatia,Greece,andChina

(Nugent).“Recently,Mexicans,Caribbeans,andabroad‐sourcedarrayofCentralAmericans

andAsians,alongwithanew(andsmaller)waveofEasternEuropeans”haveestablishedtheir

homesinChicago(Nugent).

AccordingtotheUnitedStatesCensusBureau,Chicagoisroughly228squaremilesand

in2010therewereabout2,700,000peopleresidinginChicago.About23percentofthe

populationwasundertheageof18and51.5percentwerefemale(U.S.CensusBureau).

Recently,MayorEmanuelhaslaidoutplansforaprogramcalled“HealthyChicago”,which

addressesthehealthdisparitiesamongChicago’sneighborhoods.Theareasthattheplan

addressesare:“tobaccouse,obesityprevention,HIVprevention,adolescenthealth,cancer

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disparities,heartdiseaseandstroke,accesstocare,healthymothersandbabies,

communicablediseasecontrolandprevention,healthyhomes,violenceprevention,andpublic

healthinfrastructure”(“PublicHealth”).Accordingtothe“HealthyChicagoFebruary2012

Update”thecityhasmadepositivestridestowardstheirgoalsintheareasofadolescenthealth,

cancerdisparities,communicablediseasecontrolandprevention,healthymothersandbabies,

publichealthinfrastructure,andobesityprevention(“HealthyChicago”).

TheChicagoneighborhoodIwillbeexploringisUptown.Uptownisraciallyand

ethnicallydiverse.ItisaboutsixmilesnorthoftheLoopandcontainsmanyentertainment

venuesandsocialserviceorganizations(Seligman).AccordingtotheEncyclopediaofChicago,in

2000therewere63,551residents(Seligman).TheCityofChicago’sDepartmentofPublicHealth

reportedintheir“2011SpecialSurveillanceReport:STI/HIVSurveillanceReport”thatratesof

HIVandsyphilisdiagnosesinUptownwereamongthehighestinChicago(8;19).

B. StatementoftheProblemandSubproblemwithintheTopictobeExplored

AdolescenthealthistheproblemwithinthethemethatIamexploring.Adolescenceisa

timeofrisk.Manyyoungpeoplearestartingtoidentifywhotheyareorwhattheywantto

becomeandthisstageofdevelopmentrequiresexperimentation.Withexperimentationcomes

risk.Oneoftherisksthatadolescentsmayencounteraspartofgrowingolderisdrivingacar

forthefirsttime,whileotherrisksdon’tnecessarilyhavetotakeplace,suchassexualrisk

behaviorsordruguse.

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Therearemanysubproblemswithintheproblemofadolescenthealth.Someofthese

subproblemsare:sexuallytransmitteddiseaseriskbehavior,teenpregnancy,alcoholandother

druguse,abuse,anddependence,violence,andmentalillness.

ThesubproblemIwillbeexploringinthisresearchproposalisfemaleadolescents’

sexuallytransmitteddiseaserisk.Femalesareunique,inthesensethattheyaredifferentthan

maleswhenitcomestosexuallytransmitteddiseases,becausetheyarepronetosexually

transmitteddiseasesthatwillcontinuetoplaguethemthroughouttheirlives.Accordingtothe

UnitedStatesDepartmentofHealthandHumanService’s“2009YouthRiskBehaviorSurvey,”

althoughsexualactivityamongadolescentshasdecreasedsince1991,46percentofteenagers

werehavingsex.Oftheteenagersthatwerehavingsex,62.8percentofthemusedcondoms

(JohnsonandMalow‐Iroff54).Theseareencouragingstatistics;however,ofthe46percentof

teenagersthatwerehavingsex,35percenthaveusedcontraceptivesinconsistently(Scottetal.

114).AlthoughnodatawasfoundonyouthinUptownspecifically,inChicago’s“2007Youth

RiskBehaviorSurvey,”53percentoffemaleadolescentsinChicagohadhadsexualintercourse

andeightpointsevenpercentoffemaleadolescentshadusedalcoholorotherdrugsthelast

timetheyhadhadsex(Children’sMemorialResearchCenter53;57).Additionally,63.5percent

offemaleadolescentsinChicagohadusedacondomduringtherelastsexualencounter(58).

Somewomenrelyoncondomstoprotectthemselvesfromsexuallytransmitted

infections.AccordingtotheGuttmacherInstitute,6,200,000peoplerelyoncondomstoprotect

themselves.Also,23percentofteenagewomenrelyoncondomsastheirprimarymethodof

birthcontrolandcondomuseishighinwomenages20‐24andteenagers(GuttmacherInstitute

2).

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Withthelownumberofwomenrelyingoncondomsastheirprimarymethodof

protection,thereseemstobeacorrelationbetweenthisandthefactthattheCityofChicago’s

DepartmentofPublicHealth’s“STI/HIVSurveillanceReport”foundthatin“2009oneoutof

everyfourpersonsdiagnosedwithAIDSwasundertheageof20.”Additionally,theyfoundthat

diagnosesforpeopleages13‐18wentup50percentbetween2003and2009withadolescents

andyoungadultsrepresenting39percentofthediagnosesinChicagoin2009(“Special

SurveillanceReport:STI/HIVSurveillanceReport”).

AlongwithAIDSandHIV,thelackofcondomusecanbeattributedtootherdiseases

suchaschlamydia,syphilis,andgonorrhea.AccordingtoMcCreeandPampalo,“untreated

gonococcalandchlamydialinfectionscanproducesignificantanddisproportionate

reproductivesystemmorbidityinwomen,includingpelvicinflammatorydisease,infertility,

ectopicpregnancy,andchronicpelvicpain”(310).In2007,womenaccountedforthreetimes

therateofchlamydiaovermenwith70percentofthecasesoccurringinpeopleundertheage

of25(GuttmacherInstitute;“SpecialSurveillanceReport:STI/HIVSurveillanceReport”).Thirty‐

fivepercentofchlamydiacasesand27percentofgonorrheacaseswerereportedinadolescent

ages15‐19(EitherandOrr279).Womenages15‐24werethehardesthitbychlamydia

(GuttmacherInstitute).AccordingtotheCityofChicago’sDepartmentofPublicHealth’s

“STI/HIVSurveillanceReport”three‐quartersofthechlamydiathatisreportedisamong

females.Between2009and2012,therateofsyphilisamongwomeninChicagogrewby171

percent;mostcaseswerediagnosedinpeopleages20‐29(“SpecialSurveillanceReport:STI/HIV

SurveillanceReport”).

C. StatementoftheQuestionabouttheProblemthatResearchwillAddress

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ThequestionIwillbeaddressinginthisresearchproposalis:“Whatcausessexually

transmitteddiseaseriskinadolescentfemalesintheChicagoneighborhoodofUptown?”

D. StatementoftheHypothesisthattheResearchWillTest

ThehypothesisthatIwilltestinmyproposedresearchis:“Substanceusecauses

sexuallytransmitteddiseaseriskinadolescentfemalesintheChicagoneighborhoodof

Uptown.”

E. Delimitations

• ThestudywillnotincludefemaleadolescentsoutsidetheChicagoneighborhoodofUptown.

• Thestudywillnotincludemaleadolescents.

• Thestudywillnotincludefemalesundertheageof13andovertheageof18.

F. DefinitionofTerms

Forthepurposeofthisresearchproject,termsaredefinedasfollows:

Adolescent:

AccordingtoMedlinePlusMerriam‐Websteronlinedictionary,adolescenceisdefined

as,“theperiodoflifefrompubertytomaturityterminatinglegallyattheageof

majority.”Toclarifyfurtherandforthepurposesofthisstudyadolescenceisdefinedas

femalesages13‐18.Thefemaleadolescentsinthisstudywillbeincludedregardlessof

race,sexualorientation,ethnicity,andincomebackground.

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SubstanceUse:

Substanceusewillbedefinedasusingalcoholorotherdrugs,legalorillegal,toalter

mood.Becausepeoplecanfeeltheeffectsofalcoholbeforebeinglegallydrunk,forthis

study,theamountofalcoholthatwillconstitutedsubstanceuseisoneormoredrinks.

Anyamountofdrugs(besidesalcohol)takenwillbeconsideredsubstanceuseforthis

study.

SexuallyTransmittedDisease:

AccordingtoMedNet.comasexuallytransmitteddiseaseis“anydiseasetransmittedby

sexualcontact;causedbymicroorganismsthatsurviveontheskinormucusmembranes

ofthegenitalarea;ortransmittedviasemen,vaginalsecretions,orbloodduring

intercourse.TheyincludeAIDS,chlamydia,genitalherpes,genitalwarts,gonorrhea,

syphilis,yeastinfections,andsomeformsofhepatitis.”Anothersexuallytransmitted

diseasethatwillbeincludedinthisstudyisHumanPapillomaVirus(HPV).

SexuallyTransmittedDiseaseRisk:

Engaginginsexualactivitywithoutabarriermethodofbirthcontrol(i.e.maleorfemale

condoms)orengaginginsexualactivitywithoutknowingtheirpartner’ssexually

transmitteddiseasestatus.

ChicagoNeighborhoodofUptown:

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TheneighborhoodofUptownincludestheareasbetweenFosterAvenueinthenorth

andRavenswoodAvenuetothewesttoMontroseAvenue.FromMontroseAvenuethe

bordercontinuesfromClarkStreetsouthtoIrvingParkRoadwhichmakesupthesouth

border.LakeMichiganmakesuptheeasternborder(“CityofChicagoCommunity

Areas”).

G. Assumptions

Forthepurposeofthisresearch:

• Iassumethatfemaleadolescentstakesexualrisksandwillcontinuetodoso.

• Iassumethatsexuallytransmitteddiseaseswillcontinuetobeamedical

problem.

• IassumethattheboundariesoftheneighborhoodofUptownwillnotchange.

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II.REVIEWOFRELATEDLITERATURE

A. MajorIssuesExploredbyScholarswhohaveResearchedthisTopicandSubproblem

Somehypothesesaboutwhyadolescentstakeriskregardingtheirsexualhealthhave

beenidentifiedthroughresearch.Inthisliteraturereviewsomeofthemainriskfactorsfor

adolescentsexualriskbehaviorareexploredwithanemphasisonfemaleadolescentsinthe

Chicagoarea.IchosetoproposethisresearchbecauseIdidnotfindanyresearchthat

specificallytargetedadolescentfemalesintheChicagoareawhowerenotdetainedina

juveniledetentioncenter.Additionally,Ididnotfindanyresearchthatspecificallytargetedthe

Uptownarea.Ithinkthatmyproposedresearchwillhelptofillingapsregardingthesexual

healthoffemaleadolescentsinChicago.Themostresearchedriskfactorsare:alcoholand

substanceuse,juveniledelinquencyandmentalhealth.Otherfactorsthathavebeenexplored

butarelessprominentare:parentalinvolvement,friends’influence,multiplepartners,poverty,

genderroles,andchildhoodsexualabuse.

Oneofthemostprevalenthypothesesregardingadolescentsexualriskbehavioris

substanceuse.AccordingtoTheHenryJ.KaiserFamilyFoundation,“Substanceuseincreases

theprobabilitythatanadolescentwillinitiatesexualactivity,andrelatedly,sexually

experiencedadolescentsaremorelikelytoinitiatesubstanceuse.”Thissuggestsaverystrong

relationshipbetweensexualbehaviorandsubstanceuse.Additionally,TheKaiserFamily

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Foundationreportedthatapproximately23percentofadolescents,ages15‐24,donotuse

protectionwhentheyareusingsubstances.Onestudyfollowed9,519adolescentsinsubstance

abusetreatmentbetween2002and2006.Theresearchersofthestudy,Chanandcolleagues,

foundthatfemalesweremorelikelythanmalestohavehadsexwhiledrunkorhighandwere

morelikelytohavehadunprotectedsex(117).Anotherstudyfoundthattheamountofalcohol

consumedwasdirectlyrelatedtoadecreaseincondomuse.Thestudy,conductedoncollege

agedmen,foundthatalcoholuseincreasedwhentheparticipantsinthestudyknewlessabout

thepersontheywerehavingsexwith;however,theyweremorelikelytousecondomswitha

newpartner(LaBrieetal.264).Furthermore,about90%ofadolescentssaythattheirfriends

andpeopleintheirpeergroupusedrugsoralcoholduringsex“atleastsomeofthetime”and

condomsarenotusedasoftenwhendrinkingorusingdrugs(TheHenryJ.KaiserFamily

Foundation).

Themajorityofstudiesreportedonalcoholuseamongadolescents.Hendershotand

colleagueswantedtostudytherelationshipbetweenmarijuanauseandriskysexualbehavior.

Theirlongitudinalstudy,whichinterviewedparticipantsatsixmonthintervalsfortwoyears,

wasconductedwithadolescentswhohadbeenenlistedfromjuvenileprobationoffices.They

foundthat49.4percentoftheparticipantshadusedmarijuanabeforesexduringthesixmonth

to12monthperiodandonly34.3percenthadalwaysusedcondoms(407).Subsequently,four

pointninepercentoftheparticipantshadbeendiagnosedwithanSTDatthe12month

assessment(407).

Juveniledelinquencyhasbeenidentifiedasafactorforsexualriskandtherehavebeen

severalstudiesthathavetakenplaceinjuveniledetentioncenters.Onestudy,conductedby

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Romeroandassociates,hypothesizedthatgender,race,ethnicity,andagewereafactorwhen

determiningsexriskwithincarceratedyouth.Theirlongitudinalstudyassessed800juvenile

delinquentsoverathreeyearperiod.Itconcludedthattherewerefewdifferencesintheracial

andethniccategory;however,anotherstudyconductedonjuveniledelinquentsbyMasonand

colleaguesdiscoveredthatyouthfromlow‐incomefamilieshadanearlieronsetofsexualrisk

behaviors(Romeroetal.1136;Masonetal.1379).Theirlongitudinalstudyfoundacorrelation

betweenalcoholuseinadolescentsandthelikelihoodofriskysexualbehaviorandalcoholism

inyoungadulthood(Masonetal.1381).

Thereweresomedisparitiesamongwhichgenderwasengaginginriskybehavior.A

studythatfolloweddelinquentyouthforthreeyearsfoundthatmalesaremorelikelyto

engageinmorehighriskbehaviorsbut,thebehaviorsthatweremostlikelytoincreasein

femalesastheygrewolderwere:“vaginalsex,unprotectedvaginalsex,oralsex,recent

unprotectedoralsex,unprotectedsexwhiledrunkorhigh,andtradingsexanddrugs”(Romero

etal.1129).

Accordingtoonestudy,inwhichresearchersinterviewed280sexuallyactivefemale

youthwhowerebeingdetainedinajuveniledetentioncenter,sevenfactorsthathaveaneffect

onhigherlevelsofSTIsinclude:“risktakingattitude,substanceuse,perceivedriskypeernorms,

gendernormsfavoringmaledominance,parentalmonitoring,familialsupport,andstudent

teacherconnectedness”(Voisinet.al76).Eighty‐ninepercentoftheparticipantsinthestudy

hadusedmorethanonemoodalteringchemicalinthepastyear,while37percenthadused

fourormoredrugsduringthesametimespan(75).AccordingtoanotherstudybyElkingtonet

al.,inwhichjuveniledetaineesages10‐18hadbeeninterviewed,98.3percentwhohad

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substanceusedisordersweresexuallyactiveand82.5%hadengagedinunprotectedsexwhile

theywerehighordrunk(“HIV/SexuallyTransmittedInfection”907).Thesamestudyconcluded

thatthebehaviorsmostlikelytoincreaseHIV/STIriskwere“havingvaginalsex,engaginginsex

whilehighordrunk,andhavingunprotectedsexwhilehighordrunk”(908).Whilethese

studieswereconductedonadolescentswhowerebeingdetaineditcanbeassumedthatthese

riskbehaviorswillaffectmostadolescentswhoengageinsexualactivitywhileusingsubstances.

Elkington,Bauermiester,andZimmermanlookedatasampleoveraneightyeartime

periodthatstudiedyouthfrommid‐adolescencetoyoungadulthood.Theyfoundthatinearly

adolescence,femaleshavefewerpartnersthanmaleswhilemaleshavefewerpartnersoverthe

periodofadolescence.Similarly,AfricanAmericansreportedmorepartnersthanCaucasian

youthduringearlyadolescence,whileCaucasianyouthhavemorepartnersacrossadolescence

(521).Thesesameyouthreportedmorepartnerswhentheirlevelof“psychologicaldistress”

increased(521).Thestudyalsofoundthat“substanceusepartiallymediatedtherelationship

betweenpsychologicaldistressandsexualintercoursefrequency”(522).Inotherwords,sexual

frequencywaspartiallydependentonsubstanceuseinadolescentswhohadsufferedfrom

psychologicaldistress.

Anotherareathathasbeenstudiedregardingsexualriskismentalhealth.Several

studieshavebeenconductedinsubstanceabuseandmentalhealthtreatmentfacilities.One

study,conductedbyChanandcolleagues,with9,519adolescentsinsubstanceabusefacilities

between2002and2006foundthat“adolescentswithanxietydisordersendorsedthehighest

riskofhavingsexwhiledrunkorhigh”(121).Thisstudyfoundthatadolescentswhohad

historiesoftraumaweremorelikelytohaveriskierattitudesandbehaviorsingeneral.They

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alsofoundthat39percentofthepatientshadintentionallycutthemselvesandthiswasahigh

predictorofsexualriskalongwithotherself‐harmbehaviors(Chanetal.333).Inthesame

studytheyfoundthatfemalesweremorelikelytobesexuallyactive,haveabuseorself‐harm

behaviors,andactingoutbehaviors(331).

Elkington,Bauermeister,andZimmermanalsofoundthatmentalhealthwasassociated

withanincreaseinsubstanceuse,increaseinnumberofsexualpartners,andadecreasein

condomuseduringadolescence(519;521).Theyfoundthat,“psychologicaldistressis

associatedwithsexualriskbecauseyouthwithgreaterpsychologicaldistressaremorelikelyto

usesubstances”(514).Psychiatricdisordersthatwerestudiedwere“fourmutuallyexclusive

diagnosticgroups”thatincluded“majormentaldisorder,substanceusedisorder,comorbid

majormentaldisorderandsubstanceusedisorder,andneitherdisorder”(901).

Daneen,Henry,andSchoenyfoundacorrelationbetweenparent‐childrelationshipsand

riskysexualbehavior.Thefactorstheystudiedwere“parent‐adolescentrelationship,”“parental

involvement,”“educationalaspirations,”“allowedindependence,”“sexualcommunication

attitudes,”“discussionsofsexualcost,”and“parentaldisapproval”(734).Theresearchers

foundthatthebettertherelationshiptheparentshadwiththeiradolescentsthemorelikely

theadolescentswillusecondomsandhavesexlaterinlife(736).Theyalsofoundthatthe

adolescentswhohadbetterrelationshipswiththeirparentshadalowerrateofSTDs(736).

Similarly,Voisonetal.foundthatadecreaseofparentandfamilysupportyieldedahigherSTD

ratefordetainedfemaleadolescents(74).InthebookBehavioralInterventionsforPrevention

andControlofSexuallyTransmittedDiseases,authorsKatherineEitherandDonaldOrrmention

intheirsectionentitled“BehavioralInterventionsforPreventionandControlofSTDsAmong

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Adolescents”foundthatbetterfamilyrelationshipsareassociatedwith“delayedcoitaldebut

andgreatercontraceptiveuse”amongadolescents(290).

InthebooksIreviewedanumberofinfluencesweregivenforriskyadolescentsexual

behaviors,howeveroriginalresearchwasnotconductedbytheseauthors.Inthebook

BehavioralInterventionsforPreventionandControlofSexuallyTransmittedDiseasestwo

sectionswereofparticularinteresttomysubjectarea,“BehavioralInterventionsforPrevention

andControlofSTDsAmongAdolescents”and“BiologicalandBehavioralRiskFactorsAssociated

withSTDs/HIVinWomen:ImplicationsforBehavioralIntervention.”EitherandOrr,authorsof

thesectionentitled,“BehavioralInterventionsforPreventionandControlofSTDsAmong

Adolescents,”identifiedthefollowingfactorsassociatedwithadolescentsexuallytransmitted

diseaserisk:earlyinitiationofsex,multiplepartners,unprotectedsex,andinfluenceofpartner

andmedia.McCreeandRompalo,authorsofthesectionentitled“BiologicalandBehavioral

RiskFactorsAssociatedwithSTDs/HIVinWomen:ImplicationsforBehavioralIntervention,”

discussedfactorsthatinfluenceriskysexualbehaviorinwomenwhichincludealcoholanddrug

use,poverty,genderrolesfavoringmaledominance,andahistoryofsexualabuse.Additionally,

inthebookAdolescentsandRisk,JohnsonandMalow‐Iroffemphasizedtherolesthatmedia,

friendsandalcoholandotherdruguseplayinriskyadolescentbehaviors.

Valuableresearchhasbeenconductedregardingthesexualhealthofadolescents;

however,noneoftheresearchhasfocusedonfemaleadolescentsintheUptownneighborhood

ofChicago.Myproposedresearchwillfillinthegapsfrompriorresearch.

B. MethodologiesUtilizedbyScholarstoResearchtheTopicandProblem

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TherewereseveralmethodologiesusedbytheauthorswhoseworkIreviewedtoreport

onadolescentsexualriskbehavior.Themostpopularmethodforresearchwasface‐to‐face

structuredinterviews,followedbyaudio‐computerassistedself‐interviewing,andpaperand

pencilquestionnaires.Othermethodsthatwereusedwereself‐administeredquestionnaires,

motivationalinterviewing,self‐reporting,andself‐reportusingtheGlobalAppraisalof

IndividualNeeds(GAIN)assessment.GAINisa“standardizedbiopsychosocialassessment

developedforuseinclinicalandresearchsettingswithyouthandadultspresentingto

substanceabuseandotherbehavioralhealthtreatment”andassesseseightareas:

“background,substanceuse,physicalhealth,riskbehaviors,mentalhealth,environment,legal,

andvocational”(Chanetal.115).

ThemajorityoftheresearchIlookedatcontainedquantitativeresearch;however,two

studiescontainedqualitativeresearch.Oneofthestudiesthatusedqualitativeresearchwas

conductedwith280sexuallyactiveyouthinthejuvenilejusticesystemusingacross‐sectional

approach.TheywereassessedforSTDriskbehaviorusing“computerassistedself‐interviewing

procedure”(Voisonetal.71).Theresearcherhypothesizedthat10factorswouldindicate

higherSTDrisk;however,onlysevenofthe10factorsprovedtobeindicators.Becausethe

researchersofthisstudyknewwhatvariableswouldberelevant,thisresearchstudycanbe

designatedasdescriptiveresearch.Thisstudycontainedcross‐sectionalanalysiswhichwillbe

importantformystudy;however,itusedaqualitativeapproach.Iwillnotbereplicatingthis

studybecauseIwanttoknowtheamountofwomenwhousesubstancespriortoengagingin

sexualactivity.

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Theotherstudythatcontainedqualitativeresearch,conductedbyElkington,

Bauermiester,andZimmerman,wasastudythatlookedatadolescentsduringaneightyear

longitudinalstudy.Theyusedtwomethodsforcollectingdata:structured,closeendedface‐to

face‐interviewsandself‐administeredquestionnaires(517).Thisresearchfollowedyouthfrom

mid‐adolescencetoyoungadulthood(516).Thisstudycanbedescribedasexplanatory

researchbecausetheyhadtwohypothesesandtheyweretryingtounderstandthereason

substanceuseoccurredwithadolescentswhohad“psychologicaldistress”and“HIV/STDsexual

riskbehavior”(515).ThemethodofusingquestionnaireswiththisstudyisimportantandIwill

bereplicatingitinmystudy,butIwillnotbeusingface‐to‐faceinterviews.Face‐to‐face

interviewingcanbeintrusiveanditwillnotyieldhonestanswersfromtheyoungwomen.I

thinkusingquestionnaireswillincreasethereliabilityofthefemales’answers,soIintendtouse

thismethod.

TwostudiesthatweresimilarinvolvedadolescentsattheCookCountyJuvenile

TemporaryDetentionCenter.Bothofthestudiesusedface‐to‐facestructuredinterviewsin

theirlongitudinalstudy.Eachstudyincluded800participants;however,onestudywantedto

seeifgender,race/ethnicity,andagewereafactorwhendeterminingsexualrisk(Romero

1127).Theotherwantedtodetermineifyouthwithpsychiatricdisordershadahigherlevelof

sexualrisk(“HIV/SexuallyTransmittedInfection”901).Thedataandvariablesthatwere

prevalentinbothstudiesweregender,race/ethnicity,andage,alongwithincarcerationstatus.

Again,Idon’tthinkthatinterviewingyoungadultscanyieldtruthfuldatasoIwillnotbe

interviewingtheyoungwomeninmyproposedstudy.Also,alongitudinalstudywouldnotbe

appropriateformystudybecauseIonlywantasnap‐shotofwhatishappeninginUptown.

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ThemajorityofscholarlyarticlesIreviewedcontainedlongitudinalstudieswhichcanbe

usefultodetermineandpredictsexualriskbehavior.Thelongitudinalstudieshadinitialcontact

withtheparticipantsandthendifferenttimeperiodswhentheycontactedthemagain.Astudy

conductedbyHendershotandassociatesinterviewedparticipantsatsix,twelve,eighteen,and

twenty‐fourmonthsaftertheinitialinterview(406).Atthe12monthpointtheydidacross‐

sectionalanalysisonsomeofthebehaviorsthatwerereported(408).Thedatatheycollected

wason“sexrelatedmarijuanaexpectancies,marijuana‐relatedproblems,marijuana

dependence,andbehavioralintentions”(406‐407).Thiscanbetermedasdescriptiveresearch

becausetheresearchersknewthevariablesbeforetheybegantheresearch.Descriptive

researchisthemethodthatIwillbereplicatingbecauseIwanttoaccuratelydescribewhatis

happeninginUptown.However,IwillnotbeusingalongitudinalapproachbecauseIamnot

lookingforthattypeofdata.

Hendershotandcolleaguesconductedalongitudinalstudywhichusedaudiocomputer

assistedself‐interviewsforthatstudy.Thismaybeanexcellentwayofcollectingdataon

adolescentsbecauseadolescentschangequicklyandinterviewingthematsixmonthintervals

wouldprovideimportantdata.But,reportsamongadolescentsmaynotbeasaccuratewhen

reportingsexualandsubstanceusebehaviorbecausetheymaynotfeelthattheywillretain

theiranonymity(JohnsonandMaslow‐Iroff48).However,accordingtoTourangeauandSmith,

whentalkingaboutreportedgenderdiscrepanciesamonggirlsandboys,“whensexual

behaviors,suchasthoserelatedtonumberofsexualpartners,wereassessedusinganaudio

computer‐assistedself‐report,amoreanonymousmethodofobtainingself‐reportsthanpaper

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andpencilself‐interviewsorface‐to‐faceinterviews,genderdiscrepancywassharplyreduced”

(qtd.inJohnsonandMalow‐Iroff49).

Cross‐sectionalanalysiswillbeimportantformystudybecause,forthisproject,Ionly

wantasnapshotofwhattheproblemissothatsubsequentstudiescanbuilduponit.One

articlethatcontainedcross‐sectionaldatacollectionusedaudiocomputerassistedself‐

interviewingandanotherusedapaperandpencilquestionnaire.Lescanoandcolleagues

conductedthestudythatusedpaperandpencilquestionnaires(325).Theywereactuallytrying

totesttheefficiencyofashorter“adolescentriskinventory”thanhadbeenpreviouslyused

(325).AnAdolescentRiskInventoryisatestthatis“designedtoassessadolescentrisk

behaviorsandattitudes”inapsychiatricsetting(325).AlthoughtheshorterAdolescentRisk

Inventorywasbeingtestedagainstlongerformsofthetest,itmaybeusefulifitwere

transferredtoacomputerprogramtoallowcomputerassistedself‐interviewingbecauseitwill

providemoreprivacyforadolescents.Itmaybemoreaccuratealso.Althoughtheseresearchers

weretestingtheefficiencyofashorterformofatest,itprovidedmanyvaluablevariablesand

dataaboutsexuallytransmitteddiseaserisk.

NodatahasbeencollectedonUptownregardingfemaleadolescentsexuallyhealth

usingthemethodologyIpropose.Therefore,Ithinkthatmystudywillhelptofillinthegaps

thataremissingfromthistypeofresearch.

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III.PROPOSEDRESEARCHMETHODOLOGY

A. DataorEvidencetobeCollected

ThedataIwillbecollectingwillbefromadolescentfemalesintheChicagoneighborhoodof

Uptown.Theresearchprojectwillbefromapositivistapproach.Iwillbeconducting

descriptiveresearchtodiscoverthe“whoandhow”ofsexuallytransmitteddiseaseriskin

femaleadolescents.Inotherwords,Iwillberesearchingwhoisgettingsexuallytransmitted

diseasesandhowtheyaregettingit;thedatawilldescribethecharacteristicsofthefemale

adolescentpopulationinUptownregardingsexualrisk.ThedataIcollectfromadolescent

femalesinUptownwillhelpmedetermineifsubstanceusewasaprecursortosexthatcould

causesexuallytransmitteddiseases.

1. DescriptionoftheData

TherearetwoplacesfromwhichIwillcollectdata.First,Iwillcollectinformationabout

schoolsintheUptownneighborhood.Iwillthendeterminewhichgradelevelshavefemale

studentsintheagerangeof13‐18.Becausethesamplewillberestrictedtofemaleadolescents

ages13‐18,thisstudywillcontainanominalscaleofmeasurement.Iintendtohaveastratified

randomsamplefromeachschoolandgradelevelintheUptownarea.Withthestratified

randomsampleIhopetoensureexternalvaliditybecausethesamplewillbefromdifferent

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gradelevelsanddifferentschools.IndoingthismethodIthinkthatthedatacanbegeneralized

tothesamegradelevelsindifferentareasofChicagoorthecountry.

Also,IwillcollectinformationaboutsexualhealthclinicsinUptown.Iwilldetermine

wholivesinUptownandwhoisvisitingtheclinicsfromaneighboringarea.FromthereIwill

usepurposivesamplingtodeterminesexuallytransmitteddiseaseriskinadolescentfemales

whousesubstancesbeforeintercourse.Withstratifiedrandomsamplesandpurposiverandom

samplesIwillbeusingbothprobabilityandnon‐probabilitysampling.Also,Icanhelptoensure

internalvaliditybytestingthetwodifferentgroups.Icancomparetheresultsfromtheschool

dataandthesexualhealthclinicdatatoseeifthereareanyerrorsinthedesignoftheproject

andtoseeifIamreallymeasuringsexualriskbehaviorsrelatedtosubstanceuse.

ThespecificdataIwillcollectaboutsexuallytransmitteddiseasewillbeself‐reported

sexualtransmitteddiseasethatthewomenhavecontracted.Thiscanthenbecross‐referenced

withexistingdataavailablefromtheChicagoDepartmentofPublicHealth.Specificdataabout

riskysexualbehaviorwillreportonhowmanytimesthefemalehasengagedinsexualactivity

withoutabarriermethodofbirthcontrol(i.e.maleorfemalecondoms)orengagedinsexual

activitywithoutknowingtheirpartner’ssexuallytransmitteddiseasestatus.Substanceuse

datawillbecollectedonthefemaleswhohaveconsumedanyamountalcoholorotherdrugs

priortoengaginginsexualactivity.Subsequentquestionswillaskaboutwhichsubstancewas

consumedandhowmuchwastaken.Forthisstudy,theamountofalcoholthatwillconstituted

substanceuseisoneormoredrinks.AccordingtotheNationalInstituteofDrugAbuse,one

servingofalcoholisequalto“0.6ouncesofpureethanol,or12ouncesofbeer;eightouncesof

maltliquor;fiveouncesofwine;or1.5ounces(a"shot")of80‐proofdistilledspiritsorliquor

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(e.g.,gin,rum,vodka,orwhiskey).”Additionally,anyamountofdruguse(otherthanalcohol)

willconstitutesubstanceuse.

2. WheretheDataareLocated

Iwillbeusingquestionnairesformyresearch.Subsequently,thedatawillbelocatedin

theanswerstheadolescentfemalesgivetothequestionsasked.

B. TechniqueforCollectionofData

Iwilluseaquantitativemethodforcollectdata.Itwillalsobeacross‐sectionalapproach

because,forthisstudy,Ionlywanttogeta“snapshot”ofwhatishappening.Iwillbesurveying

femalesusingquestionnairestocollectthedata.Iamusingthismethodinsteadofinterviewing

becausesexualbehaviorandsubstanceuseamongadolescentsisacontroversialtopic.Iam

hopingthattheparticipantswillbemorehonestwithsurveysthanwithothermoreblatant

measures.

ThequestionnairethatIplantodevelopwillcontaindemographicinformation,weight,

height,sexualactivity,substanceuse,substanceusebeforesexualactivity,andbirthcontrol

methods.Thequestionswillbewell‐plannedsothatIcandetermineifsubstanceuseprecedes

riskysexualbehavior.Iwillrunapilottestofthequestionnaireinordertodetermineifthe

questionsIamaskingareadequatetocollectthedatathatIwant.

Iwilldistributethequestionnairestostudentsateachschoolthroughteachersineach

oftheclasses.Also,Iwillenlistthehelpofcliniciansatsexualhealthclinicsinorderforthemto

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passoutthequestionnaires.Iwouldlikethequestionnairetobeincludedinanyintakepapers

thattheparticipantsarefillingoutforthesexualhealthclinic.Aletterwillbeincludedwiththe

surveytoassuretheparticipant’sanswerswillbekeptconfidentialandthattheywillbeableto

retaintheiranonymitythroughouttheprocess.

C. MethodofAnalysis

1. HowtheDatawillbeExaminedforMeaning

WhenthesurveysarecompleteandthedatahasbeencompiledIwillorganizethedata

accordingtotheindicatorsandvariables.IwillinputthedataintoanExcelspreadsheet.The

Excelspreadsheetwillthenconductquantitativeanalysisonthedatatodeterminefrequencyof

riskysexualbehavioramongfemaleadolescentswhowereundertheinfluenceofasubstance.

Thedemographicinformation,sexualactivity,substanceuse,andbirthcontrolmethodswill

alsobeanalyzedforpatternsthatcorrelatewithsexualintercoursewhileundertheinfluenceof

substancesamongfemaleadolescents.

IwillthenusethetablesandgraphfunctionofExceltoseeifthereareanytrends

evidentfromthedatathatwascollected.Thetablesandgraphswillincludeinformationabout

demographics,sexualactivity,substanceuse,andbirthcontrolmethods.Itwillthenbe

comparedtofemaleadolescentswhohaveanswered“yes”tothequestiontheyhadengagedin

sexualactivitywhileundertheinfluenceofalcoholorotherdrugs.Iwillseeifthereareany

patternspresentamongthedifferentvariables.

2. HowtheDatawillbePresented

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ThedatawillbepresentedinchartsandgraphsproducedbyExcel.Thefollowing

documentswillbepresented:

• AmapofUptownwithindicationsofwherethedatawascollected.

• Chartsshowingfrequencyofsexualactivity,substanceuse,andbirthcontrol

methodsaccordingtodemographicinformation.

• Achartshowingsubstanceuseamongfemaleadolescentspriortosexualactivity.

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IV.OUTLINEOFFINALREPORT

Thefinalreportwillbepresentedasfollows:

PageNumber

TitlePage i

Acknowledgements ii

TableofContents iii

ListofTables iv

ListofFigures v

Chapters

I. TheProblemandItsSettingII. ReviewofRelatedLiteratureIII. ResearchMethodologyIV. TheResults

Appendixes

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V.ExpectedOutcomes

IbelievethattheresultsofthisstudywillbenefitUptownandthecityofChicago.By

gainingabetterunderstandingoftheproblemsregardingfemaleadolescentsexually

transmitteddiseaserisk,morehelpwillbeavailabletoyoungwomen.Ithinkthatdoctors,

clinicians,andthegovernmentwillbebetterabletohelpfemaleadolescentsmakebetter

decisionsabouttheirhealth.

Doctorsandnurseswillbebetterabletotreatfemaleadolescentsbecausetheywill

haveabetterunderstandingoffemaleadolescent’sbehaviorsandtheriskswhichtheytake.

Theycanwarnfemaleadolescentsofthedangersofsexwhiledrunkorhigh.Substanceabuse

treatmentfacilityclinicianscanteachtheirclientsabouttherisksofusingalcoholorother

drugsandparticipatinginunprotectedsex.Thedoctors,nurses,andsubstanceabusetreatment

clinicianscanhelptheirpatientsplaninterventionsforwhentheyareusingsubstancessothat

theycanstillprotectthemselvesfromsexuallytransmitteddiseases.

Thegovernmentcanalsohelpplaninterventionsforprotectingfemaleadolescentsand

helpingthemadvocateforthemselves.Theycanoffermoresexualeducationclassesgeared

towardstheneedsthataresetforthinresearch.Forexample,ifacertainrace,ethnicity,age,

orgradelevelprovestobemoreatriskthensexualeducationclassescanbetailoredtoeach

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individualneed.Ifthegovernmentsetsforththeseinterventionsthenteachersandparentscan

helpwiththeprocessofeducatingyoungwomen.Theeducationthatisprovidedcanhelp

youngwomentotakebettercareoftheirsexualhealthandadvocateforthemselvesregarding

sexuallytransmitteddiseasepreventionandsubstanceuse.

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