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Weekly variations in feelings of trust predict incident STI within a prospective cohort of adolescent women from a US city
  1. Pamela A Matson1,
  2. J Dennis Fortenberry2,
  3. Shang-en Chung3,
  4. Charlotte A Gaydos4,
  5. Jonathan M Ellen5
  1. 1Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
  3. 3Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  4. 4Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
  5. 5Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, USA
  1. Correspondence to Dr Pamela A Matson, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; pmatson{at}


Objectives Feelings of intimacy, perceptions of partner concurrency (PPC) and perceptions of risk for an STD (PRSTD) are meaningful and dynamic attributes of adolescent sexual relationships. Our objective was to examine whether variations in these STI-associated feelings and perceptions predicted incident Chlamydia trachomatis and/or Neisseriagonorrhoeae infection within a prospective cohort of urban adolescent women.

Methods A cohort of clinic-recruited women aged 16–19 completed daily surveys on feelings and risk perceptions about each current sex partner on a smartphone continuously for up to 18 months. Urine was tested for C. trachomatis and N. gonorrhoeae every 3 months. Daily responses were averaged across the week. As overall means for trust, closeness and commitment were high, data were coded to indicate any decrease in feelings from the previous week. PRSTD and PPC were reverse coded to indicate any increase from the previous week. An index was created to examine the cumulative effect of variation in these feelings and perceptions. Generalised linear models were used to account for correlation among repeated measures within relationships.

Results For each week that there was a decrease in trust, there was a 45% increase in the risk of being infected with an STI at follow-up (relative risk (RR) 1.45, 95% CI 1.18 to 1.78, P=0.004). Neither a decrease in closeness or commitment, nor an increase in PRSTD or PPC was associated with an STI outcome. Cumulatively, the index measure indicated that a change in an additional feeling or perception over the week increased the odds of an STI by 14% (RR 1.14, 95% CI 1.02 to 1.29, P=0.026).

Conclusions A decrease in feelings of trust towards a main partner may be a more sensitive indicator of STI risk than PRSTD, PPC or commitment. The next generation of behavioural interventions for youth will need strategies to address feelings of intimacy within adolescent romantic relationships.

  • adolescent
  • chlamydia trachomatis
  • sexual health
  • sexual behaviour
  • neisseria gonorrhoea
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  • Handling editor Adam Huw Bourne

  • Contributors PAM and JME collaborated on the research question and study design. PAM, JME and SC chose the main directions for data analysis and interpreted results. PAM prepared the manuscript. SC performed the statistical analyses. CAG conducted the laboratory testing. JDF added to the interpretation of results and edited the manuscript. All authors commented on drafts and approved the final manuscript.

  • Funding This study was supported by the National Institute of Child Health and Human Development (NICHD R01HD058309; PI: Ellen) and the National Institute of Drug Abuse (NIDA K01DA035387; PI: Matson).

  • Competing interests None declared.

  • Ethics approval Johns Hopkins University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Requests for data sharing can be made to the first author.

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