1. K.A. Ringwood, K. K. Thomas, J.M. Marrazzo, University of Washington
The Acquisition of Bacterial Vaginosis in Lesbians and Bisexual Women
Lesbians and Sexual Abuse: Implications for STD Risk and Pregnancy Outcomes
Why is logo in B and W? I’m pretty sure I have a color one from a poster--
K.A. Ringwood, K. K. Thomas, J.M. Marrazzo,
University of Washington

2. Background: Sexual Abuse & Risk Behaviors
Childhood sexual abuse not uncommon
Rates in general U.S. population *
27% for women
16% for men
Up to 33% in MSM**
Lifelong problems with psycho-social functioning
Associated with high risk behaviors
Early age of sexual initiation
Higher rates of drug and alcohol use
Prostitution (trading sex for money)
HIV/STD infections
Unintended pregnancy
Mental health concerns
Ok but not clear how necessary--I think you need a background slide explaining why you decided to look at the relationship between abuse and risk behaviors. Would cite any data for teens, or for MSM and mental health outcomes etc.
* Finkelhor et al, 1990
** Bartholow et al, 1994

3. Background: Most lesbians have had sex with men.
National Survey of Family Growth: A-CASI interview of national sample of 12,571 U.S. adults (2002)
11% of women years old reported lifetime same-sex behavior
4.4% report female partner during the last year
Translates to 2.29 million U.S. women 18 to 44 years of age who self-identify as either homosexual or bisexual
Most self-identified lesbians have had sex with men (61% in our study); some continue to do so.
Study focused on lesbian and bisexual women because this population has a higher incidence of BV than straight women (25-52% vs 8-23%)
To provide some context, in 2002, National Survey of Family Growth conducted a national sample of 12,571 adults in the U.S.
11% of women age years reported lifetime same sex behavior, and during the last year, 4.4%
This translates to 2.29 million U.S. women 18 to 44 years of age who identify as either homosexual or bisexual
Most self-identified lesbians have had sex with men (61% IN OUR STUDY); some continue to do so
Nice, but need to correct and update references
It was your slide from another presentation. Thanks for letting me”steal” it.--kar
National Center for Health Statistics, NSFG, Cycle 6 Reports

4. Objective:
Evaluate relationships between childhood sexual abuse history in lesbians and sexual risk behaviors that have implications for STD acquisition and unintended pregnancy.

5. Definition: Child Sex Abuse
The engagement of a child in sexual activities for which the child is developmentally unprepared and cannot give informed consent.* Child sexual abuse is characterized by deception, force or coercion.
Very good! Might want to have ready in case someone asks you a question how those general US estimates were derived
* AMA, 1992
Conte, 1986

6. CASI Question: Child Sex Abuse
When you were under the age of 16, did any of the following experiences happen to you when you did not want them to happen?
An adult showed his or her sex organs to you.
You showed your sex organs to an adult at his/ her request.
An adult touched or fondled your sex organs.
You touched or fondled an adult’s sex organs
An adult performed oral sex on you.
You performed oral sex on an adult.
An adult man put his penis in your vagina.
An adult man put his penis in your anus.
Other
None of these things happened to me.
Very good! Might want to have ready in case someone asks you a question how those general US estimates were derived
Adult=person 18 years or older.

7. Methods
5 year NIH funded study on vaginal flora in lesbian and bisexual women
Subjects were recruited through ads, flyers, and word of mouth
Eligiblity: years old and sex with >1 woman in the past year
All subjects completed a detailed questionnaire detailing medical and sexual history via computer assisted self-interview (CASI) at baseline
Statistical analyses:
Fisher’s exact or T-tests to provide p-values
Logistic or Linear regressions to provide p-values adjusted for age
5 year NIH funded study examining the acquisition of Bacterial Vaginosis in lesbian and bisexual women
Subjects were recruited through ads, flyers and word of mouth
Women were eligible to enroll if they were between years of age and had sex with another woman in the past year
All subjects completed a detailed questionnaire detailing medical and sexual history via computer assisted self-interview (CASI) at baseline
Subjects were followed quarterly for 1 year

8. Findings: Demographics
335 women enrolled, median age 25 years
31% (103) report history of childhood sexual abuse before age 16
Race
CSA (n=103)
No CSA (n=232)
p-values
Black
9 (9%)
7 (3%)
.048
Non-white
29 (28%)
43 (19%)
.044
I don’t like CSA (or use of any uncommon abbreviations--would either highlight its meaning in a text box or use the whole term
CSA=Childhood Sexual Abuse

9. Findings: Sexual History with Men
Characteristics
CSA (n=103)
No CSA (n=232)
P-values
Sex with man ever
90 (89%)
178 (77%)
.010
Sex with male past yr
49 (49%)
86 (37%)
.053
Ever traded sex for money
14 (14%)
14 (6%)
.030
CSA=Childhood Sexual Abuse

10. Findings: Sexual Initiation and Lifetime Partners
Characteristics
CSA (n=103)
No CSA (n=232)
p-values
Median age at sexual initiation 14 16
.001
Median lifetime female partners 10 7
.002
Median lifetime male partners 11 6
Key slide, good
CSAs report lower rates of condom use during vaginal and anal intercourse with male partners
CSA=Childhood Sexual Abuse

11. Findings: Recent Drug Use
Characteristics
CSA (n=103)
No CSA (n=232)
p-values
Cocaine use past year
22 (24%)
26 (13%)
.026
Methamphetamine use past year
9 (10%)
7 (3%)
.048
Marijuana use past year
50 (55%)
121 (62%)
.245
Current cigarette use
40 (44%)
59 (30%)
.023
Similar associations seen for lifetime drug use
CSA=Childhood Sexual Abuse

12. Findings: Self Reported STD History
Characteristics
CSA (n=103)
No CSA (n=232)
p-values*
Genital Warts
14 (14%)
9 (4%)
.002
Gonorrhea
2 (2%)
0 (0%) 
Trich
4 (4%)
4 (2%)
.260
Chlamydia
8 (8%)
14 (6%)
.537
Bacterial Vaginosis
37 (36%)
64 (27%)
.135
PID
2 (1%)
.096
Could also omit this, summarize briefly
Will probably omit, but will mention in talk. Maybe I should combine just the genital wart history and Pap last 3 years (since both are significant) and omit the rest?
Adjusted for age  Unable to calculate age adjusted p-value
No Pap in last 3 years-12% CSA vs 6% No CSA, p=.049
CSA=Childhood Sexual Abuse

13. Findings: Pregnancy Outcomes
Characteristics
CSA (n=103)
No CSA (n=232)
p-values
Ever pregnant**
31 (34%)
22 (12%)
<.001*
Median first pregnancy
17.7 years
20 years
.025
First pregnancy result in abortion
20 (65%)
11 (48%)
.198*
Is age younger significant?
Yes--added.
* Adjusted for age ** of those reporting sex with men
CSA=Childhood Sexual Abuse

14. Findings: Mental Health Treatment
Characteristics
CSA (n=103)
No CSA (n=232)
p-values*
Ever sought psychotherapy
64 (63%)
126 (54%)
.177
Tx for Depression
43 (42%)
94 (40%)
.764
Tx for Anxiety
28 (28%)
55 (24%)
.407
Tx for PTSD
19 (19%)
11 (5%)
<.001
Tx Other mental health issues
17 (17%)
35 (15%)
.788
Prescribed meds
40 (63%)
80 (63%)
.866
Nice table but would capitalize consistently (I.e. Mental Health)
Adjusted for age
CSA=Childhood Sexual Abuse

15. Conclusions
STD/Unintended pregnancy risk for lesbian and bisexual women in VHP similar to women in other studies
Child Sex Abuse
Increase risk for mental health problems
Earlier sexual initiation
Higher number lifetime sex partners
Higher alcohol and drug use/abuse
Higher incidence of trading sex for money
Increase in risky behaviors that lead to STD and unintended pregnancy
Not sure you should start with that first bullet--the talk wasn’t really about them having sex with men, as adults. Would start by commenting on notable proportion of our subjects who reported CSA and what this was associated with (need to use your own words) Still a draft--comments or ideas? I know it’s too long. Maybe just use the major categories?

16. Why is this important? Implications
Link between CSA and HIV/STD infection
Development of timely interventions aimed at reducing trauma-related symptoms and behavioral difficulties resulting from CSA
Risk reduction for CSA survivors
Risk reduction for general public

17. Limitations Subjects were self referred or referred by partners
Limits on generalizability, reproducibility
Most subjects caucasian
People of color underrepresented

18. Acknowledgements VHP Subjects Emily Hancock Nancy Dorn Becca Hutcheson
Lauren Asaba
Judy Jacobsen
Susan Heideke
Connie Mao
Dana Varon
Laura Merrell
HMC WRC Staff Kathy Agnew

19. Findings: Sexual History & Drug/Alcohol Use Risk Behaviors
Characteristics
CSA (n=103)
NCSA (n=232)
p-values
Daily alcohol use past year
13 (14)
27 (14)
1.000
Drink 6+ drinks per day weekly or more often
8 (10)
12 (6)
0.323
Unable to stop drinking monthly or more frequently
7 (9)
11 (6)
0.428
Omit this--NS--could just state after last slide you saw no differences

20. Findings/Risks: Pap screening
Characteristic
CSA (n=103)
No CSA (n=232)
p-values*
Pap smear in past 3 yrs
78 (88)
190 (94)
0.049
Not sure so relevant? Could omit Pap in past 3 years is significant. I can omit the part about the entire population.
* Adjusted for age
CSA=Childhood Sexual Abuse NCSA= No Childhood Abuse

21. Findings/Risks: Lifetime Drug Use
Characteristics
CSA (n=103)
NCSA (n=232)
p-values
Ever used marijuana
78 (86)
170 (88)
0.681*
Ever used cocaine
45 (49)
62 (31)
0.002*
Ever used methamphetamine
31 (34)
36 (18)
0.003*
Ever used heroin
11 (12)
0.067*
First one is highlighted but isn’t significant right? Yes==saw that this was highlighted after I sent to you.
* adjusted for age
CSA=Childhood Sexual Abuse NCSA= No Childhood Abuse