The overarching goal of the proposed research is to yield a better understanding of alcohol use and STI risk among young African-American mothers, within the framework of Lazarus and Folkman's Transactional Model of Stress and Coping.1 The proposed research extends the literature by adding to the limited number of studies on sexual risk and alcohol use among young postpartum mothers,2-4 who are at high risk of STIs and repeat pregnancy.2 Alcohol use among young mothers is related to inconsistent condom use5 and appears to be related to stress and to serve as a means of coping among young minority mothers.4,6 Importantly, alcohol and substance abuse by parents of young children has been linked to impaired parenting capacity, child abuse and neglect.7 However, very few studies have explored associations between stress, alcohol use and sexual risk among young mothers. The proposed research will utilize baseline data from and serve as a supplemental study to an HIV prevention trial funded by NIAAA (1R01AA018096-01A1) to test the efficacy of an intervention to reduce sexual risk behavior and STIs among alcohol-using African-American females aged 18-24 years.
The specific aims of the proposed research are to: 1) Among young African-American women who use alcohol, compare perceived stress, alcohol use, sexual risk behavior and STI prevalence among young mothers relative to non-parenting women;2) Among young African-American mothers, describe patterns of perinatal alcohol use (resumption from pre-pregnancy, initiation, continuation from pregnancy) and examine associations between available coping resources and alcohol use and sexual risk, and 3) Qualitatively describe young African-American mothers'views on the influences between parenting, alcohol use and sexual risk behavior. The proposed research will recruit 400 participants from the parent study to complete an additional audio computer-assisted self-interview at the baseline assessment. In addition, 50 mothers participating in the parent study will be recruited to participate in focus groups. Findings from the proposed research may be useful for designing prevention interventions to improve the health of young mothers and their children and may also be useful for exploring how and why HIV/STI programs are effective or not. The proposed research will be a valuable training experience, allowing the applicant to practice, enhance and acquire new skills in support of her career goals of obtaining a university faculty appointment and becoming an independent researcher in the field of sexual, reproductive and perinatal epidemiology. The proposed training plan involves integrating research experience, coursework and trainings, and grant writing experience. The proposed research will also provide an important source of pilot data for future NIH grant submissions.

Public Health Relevance

Alcohol use among young mothers, who are at high risk for adverse sexual health outcomes such as sexually transmitted infections and repeat pregnancy, appears to be common and related to stress as well as inconsistent condom use;however, few studies have explored stress, sexual risk and alcohol use among young mothers. The proposed research will explore stress, sexual risk and alcohol use among African- American mothers 18-24 years of age. The findings are expected to inform prevention efforts to improve the health of young African-American mothers and their children.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Postdoctoral Individual National Research Service Award (F32)
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Biomedical Research Review Subcommittee (AA)
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Freeman, Robert
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Emory University
Schools of Public Health
United States
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Steiner, Riley J; Liddon, Nicole; Swartzendruber, Andrea L et al. (2016) Long-Acting Reversible Contraception and Condom Use Among Female US High School Students: Implications for Sexually Transmitted Infection Prevention. JAMA Pediatr 170:428-34
Swartzendruber, Andrea; Sales, Jessica M; Rose, Eve S et al. (2016) Alcohol Use Problems and Sexual Risk Among Young Adult African American Mothers. AIDS Behav 20 Suppl 1:S74-83
Davis, Teaniese L; Boyce, Lorin S; Rose, Eve et al. (2016) Lessons Learned From Delivering Imara, an HIV/STI Risk Reduction Intervention for African American Girls in Juvenile Detention. Health Promot Pract 17:31-9
Swartzendruber, Andrea; Steiner, Riley J; Adler, Michelle R et al. (2015) Introduction of rapid syphilis testing in antenatal care: A systematic review of the impact on HIV and syphilis testing uptake and coverage. Int J Gynaecol Obstet 130 Suppl 1:S15-21
Hulland, Erin N; Brown, Jennifer L; Swartzendruber, Andrea L et al. (2015) The association between stress, coping, and sexual risk behaviors over 24 months among African-American female adolescents. Psychol Health Med 20:443-56
Sales, Jessica M; Smearman, Erica L; Swartzendruber, Andrea et al. (2014) Socioeconomic-related risk and sexually transmitted infection among African-American adolescent females. J Adolesc Health 55:698-704
Brown, Jennifer L; Sales, Jessica M; Swartzendruber, Andrea L et al. (2014) Added benefits: reduced depressive symptom levels among African-American female adolescents participating in an HIV prevention intervention. J Behav Med 37:912-20
Steiner, Riley J; Swartzendruber, Andrea L; Rose, Eve et al. (2014) Monitoring knowledge among family, sexually transmitted infections, and sexual partnership characteristics of African American adolescent females. Sex Transm Dis 41:601-4
DiClemente, Ralph J; Davis, Teaniese L; Swartzendruber, Andrea et al. (2014) Efficacy of an HIV/STI sexual risk-reduction intervention for African American adolescent girls in juvenile detention centers: a randomized controlled trial. Women Health 54:726-49
Swartzendruber, Andrea; Sales, Jessica M; Brown, Jennifer L et al. (2014) Correlates of incident Trichomonas vaginalis infections among African American female adolescents. Sex Transm Dis 41:240-5

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