Leblanc Natalie M, Alexander Kamila, Carter Sierra, Crean Hugh, Ingram Ladrea, Kobie James, McMahon James
School of Nursing, University of Rochester Medical Center, Rochester, New York, USA.
Department of Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.
Womens Health Rep (New Rochelle). 2020 May 19;1(1):132-142. doi: 10.1089/whr.2019.0027. eCollection 2020.
Threats to sexual health can emerge across one's life span and are influenced by individual and interpersonal experiences, as well as certain environmental exposures. Although previous research has recognized the importance of ecological frameworks to understand the complexity of health and behaviors in marginalized communities, there continues to be a dearth of research that truly utilizes this perspective to gain insight into the multifaceted factors that can concurrently influence threats to sexual health among women. A sample of 279 ethnoracially diverse women were recruited from a U.S. northeastern small urban center health clinic to participate in a parent study on trauma and immunity. A hierarchical block analysis was conducted to investigate associations between women's experiences of trauma, stress and violence (, childhood trauma (CHT), intimate partner violence (IPV), neighborhood stressors), and sexual health outcomes and behaviors (, lifetime sexually transmitted infection [STI] diagnosis, concurrent partnerships, and lifetime sex trading). In the full hierarchical model, IPV and life stress trauma were associated with lifetime sex trading and partner concurrency. Also in the full model, sexual CHT was associated with lifetime STI acquisition and partner concurrency, while emotional CHT was associated with lifetime sex trading. Lastly, as neighborhood disorder increased, so did the number of lifetime sex trading partners. Sexual health assessments in clinical and community settings require a holistic, comprehensive, and meaningful approach to inform person-centered health promotion intervention. Prevention and treatment interventions require a focus on parents and families, and should assist adolescents and young adults to adopt therapies for healing from these experiences of trauma, violence, and stress. Interventions to enhance sexual health promotion must also include the following: advocacy for safe environments, social policy that addresses lifelong impacts of CHT, and fiscal policy that addresses economic vulnerability among women and threatens sexual health. Further recommendations are discussed.
性健康威胁可能在人的一生中出现，并受到个人和人际经历以及某些环境暴露的影响。尽管先前的研究已经认识到生态框架对于理解边缘化社区中健康与行为复杂性的重要性，但仍然缺乏真正利用这一视角来深入了解可能同时影响女性性健康威胁的多方面因素的研究。从美国东北部一个小城市中心的健康诊所招募了279名种族各异的女性样本，参与一项关于创伤与免疫的母体研究。进行了分层块分析，以调查女性的创伤、压力和暴力经历（童年创伤、亲密伴侣暴力、邻里压力源）与性健康结果及行为（终身性传播感染诊断、同时存在的伴侣关系和终身性交易）之间的关联。在完整的分层模型中，亲密伴侣暴力和生活压力创伤与终身性交易及伴侣同时存在有关。同样在完整模型中，性童年创伤与终身性传播感染感染及伴侣同时存在有关，而情感童年创伤与终身性交易有关。最后，随着邻里混乱程度的增加，终身性交易伴侣的数量也增加。临床和社区环境中的性健康评估需要一种全面、综合且有意义的方法，以为以个人为中心的健康促进干预提供信息。预防和治疗干预需要关注父母和家庭，并应帮助青少年和年轻人采用疗法来从这些创伤、暴力和压力经历中康复。加强性健康促进的干预措施还必须包括以下方面：倡导安全环境、解决童年创伤终身影响的社会政策，以及解决女性经济脆弱性并威胁性健康的财政政策。还讨论了进一步的建议。
