Devon Hensel

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Understanding cravings and triggers in adolescents attending a recovery high school in a COVID-19 era

According to the National Center for Drug Abuse Statistics, in 2018 some 863,000 12 to 17-year olds were diagnosed with substance use disorder (SUD). However, only .3% received the treatment necessary to begin the journey of recovery. As SUD symptoms of cravings and triggers in adolescents interfere with healthy adulthood milestone transition, it is increasingly important to investigate the real-life barriers in this unique pandemic time and beyond.

Dr. Devon Hensel has partnered with Hope Academy Recovery High School (HARHS) since 2017 to explore the integration of occupational therapy (OT) as part of the core high school recovery team. This most recent project aims to amplify the voice of members directly within the community - the adolescent students – by using real time data collection methods known as Ecological Momentary Assessments (EMAs). Dr. Devon Hensel has vast experience in recruiting and retaining large cohorts of participants for clinical and behavioral research and is a leading researcher utilizing EMA as an approach to daily collection of health and behavioral health data.

Such an approach will allow the research team to better comprehend adolescents’ daily lived experience, improve client centered care, and allow for a greater fidelity in capturing the “real life” barriers in SUD. These data will assist in producing interventions that are theory driven and help to lay the necessary groundwork for larger studies to evaluate the effectiveness of function-based interventions in order to establish occupational therapy's distinct role in SUD recovery, ultimately leading to state and national policy change.

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Recent Submissions

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    A longitudinal daily diary analysis of condom use during bleeding-associated vaginal sex among adolescent females
    (BMJ, 2016) Hensel, Devon J.; Tanner, Amanda E.; Sherrow, Ashley; Fortenberry, J. Dennis; Medicine, School of Medicine
    Objective: Sex during bleeding is a risk factor for sexually transmitted infection (STI) and other bloodborne viruses, including HIV. We examined daily predictors of adolescent women's male condom use during bleeding-associated vaginal sex. Methods: Adolescent females (N=387; 14-17 years) were recruited from primary care clinics for a longitudinal cohort study of STIs and sexual behaviour. Data were daily partner-specific sexual diaries; generalised estimating equation logistic regression assessed the likelihood of condom use during bleeding-associated vaginal sex. Results: Less than 30% of bleeding-associated vaginal sex events were condom protected. Condom use during these events was less likely with younger age, higher partner support, higher partner negativity or past week bleeding-associated sex with a given partner; condom use was more likely with high individual mood and past week condom use during bleeding-associated vaginal sex with a given partner. Conclusions: Low condom rates during bleeding-associated vaginal sex can increase STI and bloodborne virus risk. Providers should consider integrating partner-specific and behavioural factors when they deliver sexual health messages to young women.
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    A Latent Class Analysis of Sexuality Education Type and Effect on Sexual Health Outcomes Among Adolescents in the United States: Results from a Nationally Representative Study
    (Presented at Society for Adolescent Health and Medicine Conference, 2022-03) Sherwin, Nomi; Zervos, Andy; Herbenick, Debby; Paul, Bryant; Hensel, Devon
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    Changes in Solo and Partnered Sexual Behaviors during the COVID-19 Pandemic: Findings from a U.S. Probability Surve
    (medRxiv, 2020) Hensel, Devon; Rosenberg, Molly; Luetke, Maya; Fu, Tsung-chieh; Herbenick, Debby
    Background Research demonstrates that pandemics adversely impact sexual and reproductive health (SRH), but few have examined their impact on people’s participation in sex. We examined self-reported changes in solo and sexual behaviors in U.S. adults during early stages of the public health response to COVID-19. Methods We conducted an online, nationally representative, cross-sectional survey of U.S. adults (N=1010; aged 18-94 years; 62% response rate) from April 10-20, 2020. We used weighted multinomial logistic regression to examine past month self-reported changes (decreased, stable or increased) in ten solo and partnered sexual behaviors. Predictor variables included: having children at home, past month depressive symptoms, (ACHA 3-item scale), past month loneliness (UCLA 3-Item Loneliness scale), COVID-19 protection behaviors (adapted 12-item scale), perceived COVID-19 consequences (adapted 10-item scale) and COVID-19 knowledge (adapted 10-item scale). Results Nearly half of all adults reported some kind of change – most commonly, a decrease – in their sexual behavior in the past month. Having elementary aged children at home, past month depressive symptoms and loneliness and enacting more COVID-19 protective behaviors were associated with both reduced partnered bonding behaviors, such as hugging, cuddling, holding hands and kissing, as well as reduced partnered sexual behaviors, such as oral sex, partnered genital touching and vaginal sex. Greater COVID-19 risk perception and greater COVID-19 knowledge were associated with mixed effects in behavior outcomes. Conclusions Our data illustrate the very personal ways in which different pandemic-associated factors may create or inhibit opportunities for solo and partnered sex. The centrality of sexuality to health and well-being – even during pandemics – means that a critical piece of public health prevention and management responses should is ensuring that services and resource that support positive sexual decision making remain open and available.
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    Sex and Relationships Pre- and Early- COVID-19 Pandemic: Findings from a Probability Sample of U.S. Undergraduate Students
    (Springer, 2022-01-03) Herbenick, Debby; Hensel, Devon J.; Eastman-Mueller, Heather; Beckmeyer, Jonathon; Fu, Tsung-Chieh; Guerra-Reyes, Lucia
    In the wake of the COVID-19 pandemic, most U.S. colleges closed their campuses-including residence halls-causing significant disruption to students' lives. Two waves of data were collected from undergraduate students enrolled at a large U.S. Midwestern university: Wave 1 was a confidential online survey of 4989 randomly sampled undergraduate students collected in January/February 2020; Wave 2 was collected in April/May 2020 following campus closure. Our research aimed to: (1) assess how the COVID-19 related campus closure affected college students' romantic/sexual relationships, (2) examine students' past month sexual behaviors prior to the pandemic in comparison with their sexual behaviors during campus closure, and (3) compare participants' pre-pandemic event-level sexual behaviors with those occurring during campus closure. Of 2137 participants who completed both waves (49.8% women, mean age = 20.9), 2.6% were living at home in Wave 1 compared to 71.0% at Wave 2. Of those in relationships, 14.5% experienced a breakup and 25.3% stayed in their relationship but returned home to different cities. There were no statistically significant differences in participants' prior month reports of solo masturbation or sending/receiving nude/sexy images between Waves 1 and 2; however, participation in oral, vaginal, and anal sex significantly decreased across waves. Examining participants' most recent sexual events, Wave 2 sex more often occurred with a cohabiting or relationship partner and was rated as more wanted, emotionally intimate, and orgasmic. Implications for sexual health professionals are discussed.
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    Wearable biosensors have the potential to monitor physiological changes associated with opioid overdose among people who use drugs: A proof-of-concept study in a real-world setting
    (Elsevier, 2021-12-01) Roth, Alexis M.; Tran, Nguyen K.; Cocchiaro, Ben; Mitchell, Allison K.; Schwartz, David G.; Hensel, Devon J.; Ataiants, Janna; Brenner, Jacob; Yahav, Inbal; Lankenau, Stephen E.
    INTRODUCTION: Wearable biosensors have the potential to monitor physiological change associated with opioid overdose among people who use drugs. METHODS: We enrolled 16 individuals who reported ≥ 4 daily opioid use events within the previous 30 day. Each was assigned a wearable biosensor that measured respiratory rate (RR) and actigraphy every 15 s for 5 days and also completed a daily interview assessing drug use. We describe the volume of RR data collected, how it varied by participant characteristics and drug use over time using repeated measures one-way ANOVA, episodes of acute respiratory depression (≤5 breaths/minute), and self-reported overdose experiences. RESULTS: We captured 1626.4 h of RR data, an average of 21.7 daily hours/participant over follow-up. Individuals with longer injection careers and those engaging in polydrug use captured significantly fewer total hours of respiratory data over follow-up compared to those with shorter injections careers (94.7 vs. 119.9 h, p = 0.04) and injecting fentanyl exclusively (98.7 vs. 119.5 h, p = 0.008), respectively. There were 385 drug use events reported over follow-up. There were no episodes of acute respiratory depression which corresponded with participant reports of overdose experiences. DISCUSSION: Our preliminary findings suggest that using a wearable biosensor to monitor physiological changes associated with opioid use was feasible. However, more sensitive biosensors that facilitate triangulation of multiple physiological data points and larger studies of longer duration are needed.
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    Women's techniques for making vaginal penetration more pleasurable: Results from a nationally representative study of adult women in the United States
    (PloS One, 2021) Hensel, Devon J.; von Hippel, Christiana D.; Lapage, Charles C.; Perkins, Robert H.
    The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to make vaginal penetration more pleasurable. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified four previously unnamed, but distinct, techniques women use to make vaginal penetration more pleasurable: Angling, Rocking, Shallowing and Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report-a cross-sectional, online, national probability survey of 3017 American women's (age 18-93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel®. Data suggest that 87.5% of women make vaginal penetration more pleasurable using 'Angling': rotating, raising, or lowering the pelvis/hips during penetration to adjust where inside the vagina the toy or penis rubs and what it feels like. Approximately 76% of women make vaginal penetration more pleasurable using 'Rocking': the base of a penis or sex toy rubbing against the clitoris constantly during penetration, by staying all the way inside the vagina rather than thrusting in and out. About 84% of women make vaginal penetration more pleasurable using 'Shallowing': penetrative touch just inside of the entrance of the vagina-not on the outside, but also not deep inside-with a fingertip, sex toy, penis tip, tongue, or lips. Finally, 69.7% of women orgasm more often or make vaginal penetration more pleasurable using 'Pairing': when a woman herself (Solo Pairing) or her partner (Partner Pairing) reaches down to stimulate her clitoris with a finger or sex toy at the same time as her vagina is being penetrated. These data provide techniques that are at women's disposal to make penetration more pleasurable-which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.
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    Child Sexual Abuse and Negative Affect as Shared Risk Factors for Sexual Aggression and Sexual HIV Risk Behavior in Heterosexual Men
    (Archives of Sexual Behavior, 2018-02-01) Peterson, Zoё D.; Janssen, Erick; Goodrich, David; Fortenberry, J. Dennis; Hensel, Devon J.; Heiman, Julia R.
    Previous research has suggested that sexually aggressive behavior and sexual HIV risk behavior are associated. Childhood sexual abuse (CSA) is a well-established risk factor for both types of problematic sexual behavior. Negative affect (i.e., anxiety, depression, and anger) is a less well-studied risk factor, but it has been theorized to relate to both sexual aggression and HIV risk behavior. Thus, this study sought to (1) confirm the relationship between sexual aggression and HIV risk behavior, (2) establish CSA and negative affect as shared risk factors for sexual aggression and HIV risk behavior, and (3) evaluate whether negative affect mediates the relationship between CSA and sexual aggression and between CSA and HIV sexual risk in a sample of heterosexual men. We recruited 18- to 30-year-old heterosexual men (N = 377) from urban sexually transmitted infection clinics. Men completed measures of sexual HIV risk history (number of partners and condom use), sexual aggression history, CSA history, and trait negative affect (anger, anxiety, and depression). Structural equation modeling was used to examine hypothesized direct and indirect relationships. In the final SEM model, sexual aggression history and sexual HIV risk behavior were correlated. CSA was associated with both types of problematic sexual behavior. Anxiety significantly mediated the relationship between CSA and sexual aggression and between CSA and sexual HIV risk behavior (χ2[1300] = 2121.79, p < .001; CFI = 0.905; RMSEA [90% CI] = .044 [.041–.047]). Sexual aggression appears to be part of a constellation of sexual risk behaviors; thus, it may be possible to develop prevention programs that target both sexual HIV risk and sexual aggression. CSA is a shared risk factor for sexual aggression and HIV risk behavior through the pathway of anxiety. Thus, anxiety might be one promising target for intervention.
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    Adolescents' Discussion of Sexual and Reproductive Health Care Topics With Providers: Findings From a Nationally Representative Probability Sample of U.S. Adolescents
    (Elsevier, 2021-03) Hensel, Devon J.; Herbenick, Debby; Beckmeyer, Jonathon J.; Fu, Tsung-chieh; Dodge, Brian; Pediatrics, School of Medicine
    Purpose National practice guidelines encourage providers address sexual and reproductive health (SRH) as part of all clinical encounters with adolescents. Yet, no studies provide nationally representative estimates of how frequently adolescents are screened. Methods Data were adolescent participants (aged 14–17 years; N = 826) in the 2018 National Survey of Sexual Health and Behavior, an online, nationally representative study of sexual health experiences of people in the U.S. SRH variables were: (all no/yes) pregnancy prevention, sexual identity, STD/HIV prevention, sexual difficulties, sexually transmitted infections testing, and sexual activity. We used descriptive statistics and weighted logistic regression (Stata 16.0; all p < .05) to examine differences in the odds of SRH discussion with provider by sexual identity, age, gender, and race/ethnicity. Results The coverage of SRH topics was poor. The most common topic was asking about sexual activity (52.9%), and the least common was being offered a sexually transmitted infection test (21.7%). An adolescent’s sexual identity, race/ethnicity, and age affected the odds of topic screening. Conclusions Health care providers appear to both infrequently and inconsistently address key SRH topics during encounters with young people. Targeted interventions should focus on strengthening the regularity and depth of clinicians’ SRH conversations regardless of adolescent demographic or history.
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    “OMG, Yes!”: Feasibility, Acceptability, and Preliminary Efficacy of an Online Intervention for Female Sexual Pleasure
    (T&F, 2021) Hensel, Devon J.; Von Hippel, Christiana D.; Sandidge, Rebecca; Lapage, Charles C.; Zelin, Nicole S.; Perkins, Robert H.; Pediatrics, School of Medicine
    The purpose of this study was to evaluate the acceptability, feasibility, and preliminary efficacy of using an online educational resource that presents research-informed strategies for women’s pleasure, OMGyes.com, as a resource to empower women to broaden the ways in which they understand, advocate for, and enjoy sexual pleasure. A cohort of 870 adult women was given access to OMGyes.com and asked to explore the resource over a four-week period and complete online pre/post questionnaires. Participants reported a high level of satisfaction with the relatability, usefulness, and functionality of OMGyes.com. We observed statistically significant, large effect size increases in participants’ knowledge about their own pleasure preferences, their confidence and positivity about that knowledge, as well as how pleasurable their sexual experiences were during both masturbation and partner sex. Many participants reported that after using OMGyes.com they felt more motivated to explore their preferences and more confident to explain their preferences to their partners. Our data suggest that OMGyes.com may be useful for positively impacting how women think about sexual pleasure, how they understand their own specific preferences, how they advocate for what they enjoy with partners, and how they actually experience pleasure.