1. STI Disclosure Self-Efficacy in Adolescent Females L. Lowery, B. Glass, P. Parham, & J. Ellen Johns Hopkins University School of Medicine Division of General Pediatrics and Adolescent Medicine

2. Background Adolescents are at higher risk for STIs Disclosure integral part of STI counseling Variable rates of disclosure Disclosure may lead to decrease STI Previous literature –Self-efficacy, barriers to disclosure, partner type Correlated with disclosure and intent to refer partner

3. Correlates of Disclosure Individual-level factors –Self-efficacy –Perceived barriers –STI-related stigma –History of an STI Relationship-level factor –Type of sex partner- Main vs. Casual

4. Self-Efficacy A person’s belief about their capacity to perform a specific behavior/task in a specific situation Higher levels correlated –Intention for less risky health behaviors –Partner notification

5. Stigma An undesirable attribute in a person that is viewed as setting that person apart from the rest of society –Affected STI-related health care seeking –Perceived reactions to disclosure to health care providers –Concern cited by females after diagnoses

6. Objectives To describe self-efficacy, perceived barriers, and STI-related stigma in sexually experienced adolescent females To describe whether partner type and history of an STI influence attitudes around self-efficacy, perceived barriers, and STI-related stigma

7. Hypotheses Adolescent females with a history of an STI have less self-efficacy, perceive more barriers and perceive higher STI-related stigma Adolescent females have more self-efficacy and perceive more barriers related to disclosure to a main partner compared to a casual partner

8. Design Cross-sectional study –One time face to face interview Recruited adolescent females participating in larger ongoing longitudinal study Eligibility for study –14-19 years old at entry into longitudinal study –English speaking –Living within the local metropolitan area –Vaginal or anal sex within the preceding 6 months

9. Measures Individual Characteristics –Age –Self-efficacy for disclosure –Perceived barriers to disclosure –STI-related stigma Partner Type –Main vs. Casual

10. Self-Efficacy Belief about capacity to disclose an STI to a sex partner in specific situations Nine items –Adapted from Fortenberry et al.1997 & Nuwaha et al.2001 Main/Casual specific- Sample Items –“How confident are you that you could tell your main partner(s) that you had an STD?” –“How confident are you that you could tell your casual partner(s) that you had an STD?”

11. Barriers to Disclosure Eight items assessing partner-specific barriers to disclosure –i.e. violence, ending the relationship, blame for the infection, concern of partner treatment, disclosure of infection to others –Adapted from Nuwaha et. al Main/Casual specific- Sample Items –“If I told my main partner(s) that I had an STD, he would break up with me.” –“If I told my casual partner(s) that I had an STD, he would break up with me.”

12. Stigma Assess how stigmatizing she believed having an STI would be for her in the context of her relationship with her sex partner Six items –Adapted from Cunningham et al. Sample Item –“If I had an STD, my sexual partner(s) would think that I was unclean.”

13. STI History Described as either –STI at baseline of longitudinal study –Incident STI during longitudinal study prior to being enrolled in this study

14. Participants N= 140 Mean age: 20.2 years (SD=1.3) History of an STI 120/139= 86% African American females that lived in urban area

15. Scales Measures Cronbach’s  RangeMeanSD Self-efficacy Main0.899-3626.77.1 Self-efficacy Casual0.899-3626.96.9 Barriers Main0.550-84.31.4 Barriers Casual0.590-84.41.7 Stigma0.906-2413.84.6

16. History of STI & Individual Level Characteristics Individual level Characteristics STINo STI  p Self-efficacy Main26.4828.05-1.570.38 Self-efficacy Casual26.3930.05-3.670.03 Barriers Main4.254.31-0.060.89 Barriers Casual4.235.50-1.270.03 Stigma0.401.32-0.270.81

17. Comparison of Main vs. Casual MainCasualp value Mean Self-efficacy26.7126.970.56 Mean Barriers11.7911.590.29

18. Summary History of an STI –Lower level of self-efficacy for disclosure for casual partners –Lower level of perceived barriers for casual partners STI-related stigma was not associated with a history of an STI No difference in means for partner types

19. Limitations Generalizability Instrument not previously validated

20. Conclusion Adolescents had a moderate level –Self-efficacy –Perceived Barriers History of STI not associated with stigma –Potential normalization of having STI Lack of difference –May relate to rapid serial monogamy among adolescents

21. Policy Implications Better understanding of self-efficacy related to disclosure, barriers to disclosure, and STI- related stigma Programs to improve disclosure by affecting self-efficacy; disclosure and partner referral; and decreasing STI-related stigma

22. Acknowledgements Special Thank You to Shang-en Chung, ScM and Omolara Olaniyan, MD