Pediatric Prevention Research Center, School of Medicine, Wayne State University, Detroit, MI 48201, USA.
Sex Transm Dis. 2010 Nov;37(11):700-5. doi: 10.1097/OLQ.0b013e3181e1a2b2.
Multilevel analytical techniques are being applied in condom use research to ensure the validity of investigation on environmental/structural influences and clustered data from venue-based sampling. The literature contains reports of consistent associations between perceived gatekeeper support and condom use among entertainment establishment-based female sex workers (FSWs) in Guangxi, China. However, the clustering inherent in the data (FSWs being clustered within establishment) has not been accounted in most of the analyses. We used multilevel analyses to examine perceived features of gatekeepers and individual correlates of consistent condom use among FSWs and to validate the findings in the existing literature.
We analyzed cross-sectional data from 318 FSWs from 29 entertainment establishments in Guangxi, China in 2004, with a minimum of 5 FSWs per establishment. The Hierarchical Linear Models program with Laplace estimation was used to estimate the parameters in models containing random effects and binary outcomes.
About 11.6% of women reported consistent condom use with clients. The intraclass correlation coefficient indicated 18.5% of the variance in condom use could be attributed to their similarity between FSWs within the same establishments. Women's perceived gatekeeper support and education remained positively associated with condom use (P < 0.05), after controlling for other individual characteristics and clustering.
After adjusting for data clustering, perceived gatekeeper support remains associated with consistent condom use with clients among FSWs in China. The results imply that combined interventions to intervene both gatekeepers and individual FSW may effectively promote consistent condom use.
多层分析技术正被应用于 condom use（避孕套使用）研究中，以确保对环境/结构影响和基于场所抽样的聚类数据的调查有效性。文献中报告了在中国广西，基于娱乐场所的女性性工作者（FSWs）中，感知的看门人支持与 condom use（避孕套使用）之间存在一致的关联。然而，数据中固有的聚类（FSWs 聚类于场所内）在大多数分析中并未得到考虑。我们使用多层分析来检验 FSWs 中感知的看门人特征与 condom use（避孕套使用）之间的个体相关性，并验证现有文献中的发现。
我们分析了 2004 年来自中国广西 29 个娱乐场所的 318 名 FSWs 的横断面数据，每个场所至少有 5 名 FSWs。使用具有拉普拉斯估计的分层线性模型程序来估计包含随机效应和二项结果的模型中的参数。
约 11.6%的女性报告与客户持续使用 condom（避孕套）。内部类别相关系数表明， condom use（避孕套使用）的 18.5%差异可归因于同一场所内 FSWs 之间的相似性。在控制了其他个体特征和聚类后，女性感知的看门人支持和教育仍然与 condom use（避孕套使用）呈正相关（P<0.05）。
在调整数据聚类后，感知的看门人支持仍然与中国 FSWs 中与客户持续使用 condom（避孕套）相关。结果表明，针对看门人及其个体 FSWs 的综合干预措施可能有效促进 condom use（避孕套使用）的一致性。
