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Wright PJ, Herbenick D. Adolescent Pornography Exposure, Condom Use, and the Moderating Role of Parental Sexual Health Communication: Replication in a U.S. Probability Sample. HEALTH COMMUNICATION 2024:1-9. [PMID: 39104215 DOI: 10.1080/10410236.2024.2386215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Following calls for an increase in replication studies in communication science as well as multiple other disciplines, the present study provides a direct replication of a pragmatically and theoretically important investigation of U.S. adolescents' pornography exposure, parent-adolescent sexual health communication, and condomless sex published in this journal. Parent-adolescent sexual health communication has been suggested as a sexual risk-reduction mechanism, but condomless sex among U.S. adolescents is increasing. Simultaneously, pornography remains an extremely popular media genre and condomless sex is the norm in pornographic depictions. The findings of the present study replicated the findings of the original study, with the most notable replicated finding being an interaction between pornography exposure and parent-adolescent sexual health communication on the likelihood of condomless sex. Both in the original and present study, the association between U.S. adolescents' pornography exposure and likelihood of condomless sex decreased as parental-adolescent sexual health communication increased. Results are discussed in terms of the challenges to examining these particular relationships among U.S. youth and the state of replication in the pornography effects literature.
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Walden J, Stanek JR, Ebersole AM, Nahata L, Creary SE. Sexually transmitted infection testing and diagnosis in adolescents and young adults with sickle cell disease. Pediatr Blood Cancer 2024:e31240. [PMID: 39099153 DOI: 10.1002/pbc.31240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/29/2024] [Accepted: 07/19/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are common and disproportionately affect Black adolescents and young adults (AYAs). Less is known about STIs among Black AYAs with chronic conditions, such as sickle cell disease (AYAs-SCD). This study compared STI testing and diagnosis between AYAs-SCD and their peers, overall and among STI-related encounters. PROCEDURE This retrospective, cross-sectional study used diagnosis and billing codes in the Pediatric Health Information System (PHIS) to identify inpatient and emergency department encounters from January 1, 2022 to May 31, 2023 among all AYAs 15-24 years and those with STI-related diagnoses (e.g., "cystitis"). STI testing and diagnosis rates were compared between AYAs-SCD, non-Black AYAs, and Black AYAs, controlling for age, sex, and encounter setting. RESULTS We identified 3602 AYAs-SCD, 177,783 Black AYAs, and 534,495 non-Black AYAs. AYAs-SCD were less likely to be tested for STIs than non-Black AYAs (odds ratio [OR] = 0.26; adj. p < .001) and Black AYAs (OR = 0.53; adj. p < .001). When tested, AYAs-SCD were more likely to be diagnosed with an STI than non-Black AYAs (OR = 2.39; adj. p = .006) and as likely as Black AYAs (OR = 0.67; adj. p = .15). Among STI-related encounters, AYAs-SCD were less likely to be tested than non-Black AYAs (OR = 0.18; adj. p < .001) and Black AYAs (OR = 0.44; adj. p < .001). No significant differences in STI diagnoses were found in this subset between AYAs-SCD and non-Black AYAs (OR = 0.32; adj. p = .28) or Black AYAs (OR = 1.07; adj. p = .99). CONCLUSIONS STI care gaps may disproportionately affect AYAs-SCD. STIs should be considered when evaluating symptomatic AYAs-SCD in acute settings. More research is needed to further contextualize STI care for AYAs-SCD.
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Affiliation(s)
- Joseph Walden
- Abigail Wexner Research Institute, Center for Child Health Equity and Outcomes Research, Columbus, Ohio, USA
| | - Joseph R Stanek
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ashley M Ebersole
- Division of Adolescent Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leena Nahata
- Abigail Wexner Research Institute, Center for Biobehavioral Health, Columbus, Ohio, USA
- Division of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Susan E Creary
- Abigail Wexner Research Institute, Center for Child Health Equity and Outcomes Research, Columbus, Ohio, USA
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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Wright PJ, Tokunaga RS, Herbenick D. Pornography, identification, alcohol, and condomless sex. THE JOURNAL OF COMMUNICATION 2024; 74:198-211. [PMID: 38841539 PMCID: PMC11149618 DOI: 10.1093/joc/jqae009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/17/2024] [Accepted: 01/27/2024] [Indexed: 06/07/2024]
Abstract
Using national probability data from the 2022 National Survey of Sexual Health and Behavior, the present study evaluated whether moderators of the association between frequency of pornography exposure and condomless sex are consistent with the sexual script acquisition, activation, application model's (3AM) suppositions about the facilitating effects of wishful identification and decreased self-regulation and forethought capacity. Consistent with the 3AM, two-way interaction effect analysis indicated that the strength of the positive association between exposure frequency and condomless sex increased as identification intensified. Inconsistent with the 3AM, two-way interaction effect analysis indicated that the association between exposure frequency and condomless sex was not significantly different among those who had and had not consumed alcohol before their last sexual encounter. However, the three-way interaction between exposure frequency, identification, and alcohol use did suggest a role for each 3AM moderator, as the catalyzing effect of identification was operable among those who had consumed alcohol only.
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Affiliation(s)
- Paul J Wright
- The Media School, Indiana University, Bloomington, IN, USA
| | - Robert S Tokunaga
- Department of Communication, University of Texas at San Antonio, San Antonio, TX, USA
| | - Debby Herbenick
- The Center for Sexual Health Promotion, The School of Public Health at Indiana University, Bloomington, IN, USA
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Cohall A, Cohall R, Rais M, Zucker J, Sanchez D, Carnevale C, Gonzalez-Davila M. Implementing an STI screening initiative in New York City community colleges. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1034-1040. [PMID: 35622981 DOI: 10.1080/07448481.2022.2068018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/19/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Objectives: Nationally, community colleges provide academic instruction to 5.6 million students annually. However, sexual health services, are often lacking. This pilot study was developed to assess the feasibility of implementing screening for sexually transmitted infections in community college settings in New York City where approximately 86,075 students attend classes. Methods: We recruited and trained an interdisciplinary group of graduate students (public health, nursing, and post-baccalaureate/pre-med) to provide sexual health risk assessments, screening for sexually transmitted infections, and linkages to care at three community college campuses in New York City. Results: Over a three-year period (2017-2019), 545 students were screened for STIs and 7.2% were positive for Chlamydia. Conclusions: Community college students are at high risk for sexually transmitted infections yet have limited access to sexual health services. Coordinated partnerships between state and local departments of health, public health schools, and an academic medical center demonstrate an important model which can fill identified gaps for this vulnerable population.
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Affiliation(s)
- Alwyn Cohall
- Columbia University Mailman School of Public Health, New York City, New York, USA
- Columbia University Irving Medical Center, New York City, New York, USA
| | - Renee Cohall
- Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Monica Rais
- Columbia University School of General Studies, New York City, New York, USA
| | - Jason Zucker
- Columbia University Irving Medical Center, New York City, New York, USA
| | - Diana Sanchez
- Department of Health and Mental Hygiene, New York City, New York, USA
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Séguin LJ, Gareau E, Bosom M. DépistaFest: The evaluation of an inclusive, positive, and playful STBBI screening campaign's effectiveness. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:250-258. [PMID: 38393551 PMCID: PMC11027723 DOI: 10.17269/s41997-024-00862-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES Young adults are disproportionately affected by sexually transmitted and blood-borne infections (STBBIs), and rates of STBBI screening in this population are persistently low. The present study examined the effectiveness of Club Sexu's social marketing campaign, DépistaFest, in increasing STBBI screening, screening intentions, and general STBBI and STBBI screening knowledge among young adults in Quebec, Canada. Grounded in the health belief model, the campaign provided practical and scientifically accurate information on STBBIs and screening using an inclusive, positive, and playful approach. METHODS A sample of 686 participants (M = 28.0 years old) was recruited through Club Sexu's social media to complete an online survey assessing campaign exposure, recent STBBI screening, screening intentions, and general STBBI and screening knowledge. Logistic regressions and ANCOVAs were performed to examine group differences on outcome variables. RESULTS Compared to nonexposed participants, those who were exposed to the campaign were 2.11 times more likely to report having been tested in the past 6 months, and 2.07 times more likely to report planning to get tested in the next 6 months. Exposed participants were also more likely to correctly answer general STBBI knowledge questions and reported higher levels of self-perceived STBBI screening knowledge than nonexposed participants. CONCLUSION The findings support the effectiveness of an STBBI prevention campaign grounded in the health belief model. Future STBBI prevention campaigns aimed at young adults would benefit from destigmatizing STBBIs and normalizing STBBI screening using an inclusive, positive, and playful approach.
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Affiliation(s)
- Léa J Séguin
- Department of Sexology, Université du Québec à Montréal (UQÀM), Montreal, QC, Canada.
| | - Emmanuelle Gareau
- School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Morag Bosom
- Department of Sexology, Université du Québec à Montréal (UQÀM), Montreal, QC, Canada
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Toma E, Malyuta Y, Salhaney P, Nunn A, Maynard M, Tao J, Sutten Coats C, Chan PA. Implementation of Point of Care Sexually Transmitted Infections Testing in a Community Clinic Setting. Sex Transm Dis 2024; 51:251-253. [PMID: 38301625 DOI: 10.1097/olq.0000000000001943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
ABSTRACT The rates of sexually transmitted infections (STIs) in the United States, including chlamydia and gonorrhea, are rising. Point-of-care (POC) testing could increase access to testing and treatment. This evaluation found POC STI testing to be concordant with the results of traditional laboratory testing for 100% of patients who were tested. Ninety-five percent of the patients reported being satisfied with the experience, and 66% preferred it to traditional laboratory testing. The most commonly reported reason for preferring the test was the short amount of time it took to receive results. However, insurance reimbursed less than 30% of what was billed for the POC tests. Low insurance reimbursement rates could be a barrier to implementation long-term financial sustainability of POC STI testing.
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Affiliation(s)
- Emily Toma
- From the Department of Medicine, Brown University, Providence, RI
| | - Yelena Malyuta
- Open Door Health, Rhode Island Public Health Institute, Providence, RI
| | - Peter Salhaney
- Open Door Health, Rhode Island Public Health Institute, Providence, RI
| | - Amy Nunn
- Open Door Health, Rhode Island Public Health Institute, Providence, RI
| | - Michaela Maynard
- Open Door Health, Rhode Island Public Health Institute, Providence, RI
| | - Jun Tao
- From the Department of Medicine, Brown University, Providence, RI
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Lightfoot M, Campbell C, Maragh-Bass AC, Jackson-Morgan J, Taylor K. What Adolescents Say in Text Messages to Motivate Peer Networks to Access Health Care and Sexually Transmitted Infection Testing: Qualitative Thematic Analysis. J Med Internet Res 2024; 26:e44861. [PMID: 38416541 PMCID: PMC10938228 DOI: 10.2196/44861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 07/06/2023] [Accepted: 01/11/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND While rates of HIV and sexually transmitted infections (STIs) are extremely high among adolescents and young adults in the United States, rates of HIV and STI testing remain low. Given the ubiquity of mobile phones and the saliency of peers for youths, text messaging strategies may successfully promote HIV or STI testing among youths. OBJECTIVE This study aimed to understand the types of messages youths believe were motivating and persuasive when asked to text friends to encourage them to seek HIV or STI testing services at a neighborhood clinic. METHODS We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance and increase STI and HIV testing among youths (n=100) at an adolescent clinic in San Francisco, California. Participants were asked to send a text message to 5 friends they believed were sexually active to encourage their friends to visit the clinic and receive STI or HIV screening. Thematic analysis was used to analyze the content of the text messages sent and received during the clinic visit. Member checking and consensus coding were used to ensure interrater reliability and significance of themes. RESULTS We identified four themes in the messages sent by participants: (1) calls to action to encourage peers to get tested, (2) personalized messages with sender-specific information, (3) clinic information such as location and hours, and (4) self-disclosure of personal clinic experience. We found that nearly all text messages included some combination of 2 or more of these broad themes. We also found that youths were inclined to send messages they created themselves, as opposed to sending the same message to each peer, which they tailored to each individual to whom they were sent. Many (40/100, 40%) received an immediate response to their message, and most participants reported receiving at least 1 positive response, while a few reported that they had received at least 1 negative response. There were some differences in responses depending on the type of message sent. CONCLUSIONS Given the high rates of STI and HIV and low rates of testing among adolescents, peer-driven text messaging interventions to encourage accessing care may be successful at reaching this population. This study suggests that youths are willing to text message their friends, and there are clear types of messages they develop and use. Future research should use these methods with a large, more diverse sample of youths and young adults for long-term evaluation of care seeking and care retention outcomes to make progress in reducing HIV and STI among adolescents and young adults.
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Affiliation(s)
- Marguerita Lightfoot
- School of Public Health, Oregon Health & Science University - Portland State University, Portland, OR, United States
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, United States
| | - Chadwick Campbell
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, United States
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | - Allysha C Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | | | - Kelly Taylor
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, United States
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
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Rosen AO, Bergam L, Holmes AL, Krebs E, Moreno M, Muñiz GS, Huedo-Medina TB. Efficacy of behavioral interventions to increase engagement in sexual health services among LatinX youth in the United States: A meta-analysis for post-pandemic implications. Int J Adolesc Med Health 2024; 36:1-15. [PMID: 38373148 PMCID: PMC10904879 DOI: 10.1515/ijamh-2022-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/30/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION LatinX youth in the U.S. are disproportionately affected by HIV and STIs, commonly attributed to a lack of diagnostic testing and regular physician consultations to address sexual health. These disparities have been exacerbated by the COVID-19 pandemic. This meta-analysis seeks to assess the efficacy of behavioral interventions among LatinX youth in the U.S. that aim to increase engagement in sexual health services (i.e., STI/HIV testing, physician consultations). CONTENT Following PRISMA guidelines, seven electronic databases were searched. We systematically extracted data with a coding form, and effect sizes were obtained from each study on HIV/STI testing outcomes and physician consultation. Moderator analyses were run for demographic and intervention characteristics. SUMMARY AND OUTLOOK Of nine included studies, the interventions created a small-to-moderate effect on increased engagement of sexual health services (d +=0.204, 95 % CI=0.079, 0.329). Moderator analyses showed that interventions including the following characteristics were most efficacious at facilitating care services: community-based or online setting, access to diagnostic testing, social media/remote components, parental involvement, and longer session duration. This meta-analysis provides informative results regarding behavioral interventions that have proven efficacious in facilitating engagement in sexual health services among LatinX youth. Most prominently, interventions that are remote or through social media, community-based, and incorporated parents had large positive effects. These findings prove useful for the ongoing COVID-19 pandemic situation and provide guidance for targeting LatinX youth to engage them in sexual health services as primary and secondary STI and HIV prevention.
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Affiliation(s)
- Aviana O. Rosen
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Ashley L. Holmes
- Department of Health Policy, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Emma Krebs
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Melanie Moreno
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Geycel S. Muñiz
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Tania B. Huedo-Medina
- Department of Clinical, Health Psychology and Research Methodology, University of the Basque Country, San Sebastian - Donastia, Spain
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Unger ES, McConnell M, Austin SB, Rosenthal MB, Agénor M. Examining the Association Between Affordable Care Act Medicaid Expansion and Sexually Transmitted Infection Testing Among U.S. Women. Womens Health Issues 2024; 34:14-25. [PMID: 37945444 DOI: 10.1016/j.whi.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Sexually transmitted infection (STI) rates are rising among women in the United States, increasing the importance of routine STI testing. Beginning in 2014, some states expanded Medicaid under the Affordable Care Act, providing health coverage to most individuals in and near poverty. Here, we investigate whether Medicaid expansion changed rates of STI testing among U.S. women. METHODS We analyzed nationally representative 2011-2017 National Survey of Family Growth data from U.S. women ages 15-44. Using difference-in-differences analysis, we assessed whether Medicaid expansion was associated with within-state changes in the prevalence of STI testing in the past 12 months, among women overall and by race/ethnicity and sexual orientation, during each year following Medicaid expansion. Models were adjusted for individual- and state-level demographic and socioeconomic factors. RESULTS Our sample included 14,196 U.S. women. Medicaid expansion was associated with higher STI testing rates, which increased over time. By 3 years post-expansion, expansion states had increased STI testing by 12.7 percentage points more than nonexpansion states (95% confidence interval [CI] [2.5, 23.0], p = .016). This association was imprecisely estimated within racial/ethnic and sexual orientation subgroups, but trended strongest among white, Latina, and heterosexual women, followed by Black and bisexual women (who tested more often at baseline). CONCLUSIONS Medicaid expansion is associated with increased STI testing among U.S. women; these benefits grew over time but varied by both race/ethnicity and sexual orientation. State governments that fail to expand Medicaid may harm their residents' health by allowing more spread of STIs.
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Affiliation(s)
- Emily S Unger
- Cambridge Health Alliance Family Medicine Residency, Malden, Massachusetts.
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Harvard T.H. Chan School of Public Health/Boston Children's Hospital, Boston, Massachusetts
| | - Meredith B Rosenthal
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Madina Agénor
- Department of Behavioral and Social Sciences and Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
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Zapata JP, Queiroz A, Rodriguez-Diaz CE, Mustanski B. Factors Associated with HIV Testing Among Spanish and English-Speaking Latino Adolescents Aged 13-18. AIDS Behav 2024; 28:343-356. [PMID: 37848599 DOI: 10.1007/s10461-023-04206-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
Adolescent Latino men who have sex with men (LMSM) in the U.S. are disproportionately impacted by HIV. However, there has been limited focus on their HIV prevention and risk behaviors. In this study, we examine the rates of HIV testing and explore the significant demographic and healthcare factors that influence HIV prevention among adolescent LMSM. The analysis for this study utilized data collected during the baseline assessment of SMART, a pragmatic trial aimed at evaluating the effectiveness of an online HIV prevention intervention for adolescent LMSM (N = 524). Only 35.5% of participants had ever had an HIV test in their lifetime. Rates of testing increased among adolescent LMSM who had a doctor with whom they spoke about their sexual health (odds ratio: 4.0; 95% confidence interval: 2.1-8.4; P < 0.001) or HIV testing (odds ratio: 5.8; 95% confidence interval: 3.1-10.7; P < 0.001). Out of the 61 participants who took part in the survey conducted in Spanish, only 26% reported ever having an HIV test. Additionally, 24.5% stated that they had discussed their sexual orientation with a doctor, and only 8.2% had undergone HIV testing. Spanish-speaking adolescents who completed the SMART survey were less likely to openly discuss their sexual orientation or sexual health with most people or have a doctor with whom they discussed these topics, compared to those who completed the survey in English. These findings suggest that Spanish-speaking adolescent LMSM may face obstacles in accessing HIV prevention services in the U.S.
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Affiliation(s)
- Juan Pablo Zapata
- Department of Medical Social Science and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA
| | - Artur Queiroz
- Department of Medical Social Science and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA
| | - Carlos E Rodriguez-Diaz
- School of Public Health, Boston University, 801 Massachusetts Ave. Suite 431, Boston, MA, USA
| | - Brian Mustanski
- Department of Medical Social Science and the Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA.
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Sao SS, Yu R, Barre-Quick M, Abboud S, Deshmukh S, Wang R, Coleman JS. Through Their Eyes: Youth Perspectives on Sexual and Reproductive Health Barriers and Facilitators in Baltimore, Maryland. J Adolesc Health 2023; 73:983-991. [PMID: 37395698 DOI: 10.1016/j.jadohealth.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/26/2023] [Accepted: 05/07/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Youth face barriers to sexual and reproductive health (SRH). Few states require the delivery of comprehensive sex education in schools, and youth report challenges with accessing clinical care. We sought to identify youth's perceived barriers and facilitators to SRH in their communities. METHODS We utilized photovoice, a community-based participatory research methodology. Youth were recruited from high schools in Baltimore, Maryland. Participants were given a tutorial on Photovoice methodology and photography. In groups of 5-7 participants, youth brainstormed questions relevant to their perspective of SRH. Three months were allocated to taking photographs. Participants wrote brief narratives to accompany their photographs, and group level assessment was used for participants to comment on others' photographs. Participants discussed the narratives and comments, created themes, and generated action steps to address barriers to SRH. Further thematic analysis was conducted using NVivo. RESULTS There were 30 participants aged 14-19 years with 26 self-identifying as female and four nonbinary. Self-identified race/ethnicity included 50% Black/African American, 30% Asian American, and 20% White or Hispanic/Latino. Four domains emerged: desire for societal-level change, community-level change, peer-level change, and positive examples of SRH within their communities (e.g., gender-inclusive spaces and free menstrual products). DISCUSSION Youth photographs shed light on a strong desire for an improved school environment, in terms of safety, cleanliness, gender-inclusivity, menstrual product access, and SRH education.
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Affiliation(s)
- Saumya S Sao
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Ruoxi Yu
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Runzhi Wang
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jenell S Coleman
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Cooley-Strickland M, Wyatt GE, Loeb TB, Nicholas LA, Smith-Clapham A, Hamman A, Abraham M, Scott EN, Albarran G. Need for Sexual, Reproductive, and Mental Health Promotion Among Diverse College Students in a COVID-19 Era. Clin Child Fam Psychol Rev 2023; 26:1077-1096. [PMID: 37934361 PMCID: PMC10640429 DOI: 10.1007/s10567-023-00460-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 11/08/2023]
Abstract
In 2020, the COVID-19 pandemic forced unprecedented disruptions in higher education operations. While the adverse mental health effects experienced by college students due to these changes are well documented, less is known about the impact on their sexual and reproductive health (SRH), and the reciprocal relationships between SRH and mental health among adolescents and emerging adults. This position paper reviews existing literature on the effects of the COVID-19 pandemic on SRH, sexual violence, unintended pregnancy, sexually transmitted illness and human immunodeficiency virus rates and highlights issues specific to college-aged males, females, racial/ethnic and sexual minorities, and individuals with disabilities. The need to conceptualize SRH as an integral component of normal development, overall health, and well-being in the context of COVID-19 is discussed. The need to prioritize the design and implementation of developmentally appropriate, evidence-based SRH interventions specifically targeting college students is identified. Furthermore, an intergenerational approach to SRH that includes parents/caregivers and/or college faculty and staff (e.g., coaches, trainers) could facilitate comprehensive SRH prevention programming that enhances sexual violence prevention training programs currently mandated by many colleges. Policies and programs designed to mitigate adverse pandemic-related exacerbations in negative SRH outcomes are urgently needed and should be included in mainstream clinical psychology, not only focused on preventing unwanted outcomes but also in promoting rewarding interpersonal relationships and overall well-being. Recommendations for clinical psychologists and mental health researchers are made.
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Affiliation(s)
- Michele Cooley-Strickland
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA.
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Gail E Wyatt
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Tamra Burns Loeb
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Lisa A Nicholas
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amber Smith-Clapham
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Amina Hamman
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Misha Abraham
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Enricka Norwood Scott
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
| | - Graciela Albarran
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024-1759, USA
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13
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Sao SS, Yu R, Abboud S, Barre-Quick M, Deshmukh S, Wang R, Coleman JS. Utilizing Digital Health Technology to Increase Sexual Health Care Access: Youth Preferences on Self-Collect, Mail-In Sexually Transmitted Infection Testing in a High Sexually Transmitted Infection Prevalence Area. J Adolesc Health 2023; 73:1002-1009. [PMID: 37676195 PMCID: PMC10935575 DOI: 10.1016/j.jadohealth.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE The COVID-19 pandemic highlighted the need for innovative approaches to delivering care. Self-collect, mail-in sexually transmitted infection (STI) testing could address barriers to in-person STI testing, particularly for youth, who bear a disproportionate burden of STIs. This study sought to obtain youth input on the development of a free self-collect, mail-in STI testing program. METHODS Focus group discussions (n = 5, 45-60 minutes each) were conducted with 28 youth ages 14-19 years old living in Baltimore, Maryland. Focus group discussions were based on a conceptual framework of patient-centered health-care access, and a prototype online program was discussed. Transcribed data were coded thematically. Memos were written to synthesize findings and identify representative quotes. RESULTS Participants noted existing barriers to in-person STI testing barriers including individual-level (e.g., lack of knowledge), interpersonal-level (e.g., stigma), and structural-level (e.g., financial). Although participants expressed concerns about self-collect, mail-in STI testing (e.g., accuracy of self-swabbing), there was overall acceptance of the program, and many felt it would address current barriers to testing. Opportunities to improve the testing program included all four steps of testing process: kit ordering, receipt of the kit and swabbing, post-testing experience, and communication of results and treatment. Specifically, participants desired expanded shipping options to schools, and mail drop-off points such as lockers and local convenience stores; more transparency about testing and treatment; and hearing directly from health-care providers to assuage any concerns. DISCUSSION Self-collect, mail-in STI testing was favorable among youth, and could be a viable option for increasing youth access to STI testing.
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Affiliation(s)
- Saumya S Sao
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Ruoxi Yu
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | | - Runzhi Wang
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jenell S Coleman
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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14
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Wright PJ, Tokunaga RS, Herbenick D. Model Specification in Media Effects Research. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3181-3188. [PMID: 37814100 PMCID: PMC11167628 DOI: 10.1007/s10508-023-02714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Paul J Wright
- Communication Science Unit, The Media School, Indiana University, 601 East Kirkwood Avenue, Bloomington, IN, 47405, USA.
| | - Robert S Tokunaga
- Department of Communication, University of Texas, San Antonio, TX, USA
| | - Debby Herbenick
- The Center for Sexual Health Promotion, The School of Public Health at Indiana University, Bloomington, IN, USA
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15
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Sao SS, Barre-Quick M, Yu R, Abboud S, Coleman JS. Advancing Access to Care through Digital Health: Perspectives from Youth on a Novel Platform to Increase Access to Sexual and Reproductive Health Care and Education for Adolescents and Young Adults. J Pediatr Adolesc Gynecol 2023; 36:449-454. [PMID: 37084876 PMCID: PMC10916889 DOI: 10.1016/j.jpag.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/01/2023] [Accepted: 04/16/2023] [Indexed: 04/23/2023]
Abstract
STUDY OBJECTIVE Youth account for half of new sexually transmitted infections (STIs) in the United States annually. Barriers to STI prevention include a lack of accurate sexual and reproductive health (SRH) education and low STI testing. We sought to obtain youth feedback on a digital health platform prototype designed to address these barriers. METHODS The platform prototype included SRH content, free STI testing and treatment, and anonymous question submission. Five focus group discussions, each lasting 45-60 minutes with 5-6 youth living in a high-prevalence STI region (Baltimore, Maryland), were conducted. Thematic analysis was conducted. RESULTS There were 28 participants with a mean age of 15.9 years (range 14-19), among whom 89% self-identified as female, 57% Black/African American, 29% Asian American, 14% White, and 7% Hispanic/Latino. Youth felt that the prototype platform was comprehensive and understandable. They suggested adding peer reviews to increase trustworthiness. CONCLUSION Youth reported that the platform (violetproject.org) was an acceptable tool for SRH education and STI testing. Participants expressed enthusiasm and willingness to use the platform as a reliable SRH educational tool to combat medical misinformation on the Internet and a non-clinic-based source of STI testing. This platform could fill gaps in access to SRH care and education for youth.
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Affiliation(s)
- Saumya S Sao
- Johns Hopkins School of Medicine, Baltimore, Maryland.
| | | | - Ruoxi Yu
- Johns Hopkins School of Medicine, Baltimore, Maryland
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16
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Adeyeba M, Schmidt CM, Alba Rosales AD, Su D, Dai H, Tibbits M. A review of bidimensional acculturation and STI/HIV-related sexual risk behaviours among Hispanic youth. CULTURE, HEALTH & SEXUALITY 2023; 25:1259-1276. [PMID: 36579632 DOI: 10.1080/13691058.2022.2154387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/29/2022] [Indexed: 12/30/2022]
Abstract
A growing body of research suggests that acculturation may play a role in the disproportionate likelihood of sexual risk behaviour and STI/HIV infection among Hispanic youth in the USA. We systematically reviewed the relationship between acculturation and STI/HIV-related sexual risk behaviour among Hispanic youth aged 13-24 by reviewing studies that have used a bidimensional acculturation approach. Electronic databases were searched with the searches limited to articles published in 1992 when the concept of bidimensional acculturation was introduced or later. Two independent researchers screened the full data set to assess eligibility. Six studies were included. Three studies used cross-sectional data, while the other three used longitudinal data. We discovered that sexual risk behaviours differed by Hispanic youth acculturation types and were moderated by gender. We found that Hispanic acculturated youth had lower odds of having multiple sex partners than US acculturated youth. However, the relationship between acculturation and condom use yielded contradictory results and we could find no report on bi-culturation and sexual behaviour. Additional research is needed to explore whether adopting both US and Hispanic-heritage cultures at the same time may reduce or increase the odds of engaging in sexual risk behaviour among Hispanic youth in the USA.
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Affiliation(s)
- Mariam Adeyeba
- Nebraska Medical Center, University of Nebraska, Omaha, Nebraska, USA
| | - Cynthia M Schmidt
- Nebraska Medical Center, University of Nebraska, Omaha, Nebraska, USA
| | | | - Dejun Su
- Nebraska Medical Center, University of Nebraska, Omaha, Nebraska, USA
| | - Hongying Dai
- Nebraska Medical Center, University of Nebraska, Omaha, Nebraska, USA
| | - Melissa Tibbits
- Nebraska Medical Center, University of Nebraska, Omaha, Nebraska, USA
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17
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Canabarro APF, Eriksson M, Nielsen A, Zeebari Z, Salazar M. Cognitive social capital as a health-enabling factor for STI testing among young men in Stockholm, Sweden: A cross-sectional population-based study. Heliyon 2023; 9:e20812. [PMID: 37876418 PMCID: PMC10590937 DOI: 10.1016/j.heliyon.2023.e20812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 09/12/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023] Open
Abstract
Objective To assess whether different forms of cognitive social capital increased the relative probability of testing for sexually transmitted infections (STIs) among young men living in Stockholm, Sweden. Methods A population-based cross-sectional study was conducted in 2017 with men aged 20-29 years living in Stockholm County, Sweden (n = 523). The main outcome was STI testing patterns (never tested, tested only within a12-monthperiod, tested only beyond a12-monthperiod, repeatedly tested). The main exposure were two forms of cognitive social capital: social support (having received help, having someone to share inner feelings with) and institutionalized trust (in school, healthcare, media). Data were analyzed using weighted multivariable multinomial logistic regression to obtain adjusted weighted relative probability ratio (aRPR). Results After adjusting for confounding factors, receiving help (aRPR: 5.2, 95% CI: 1.7-16.2) and having someone to share inner feelings with (aRPR: 3.1, 95% CI: 1.2-7.7) increased the relative probabilities of young men testing for STIs, but only for those testing beyond a 12-month period. Trust in media increased the relative probability of STI testing for those testing only within a 12-month period (aRPR: 2.6, 95% CI: 1.1-6.1) and for those testing repeatedly (aRPR: 3.6, 95% CI: 1.5-8.8). Conclusion Young men in Stockholm County exhibit distinct STI testing patterns. Social support and trust in media were factors that increased the probability of being tested for STIs, with this effect varying according to the young men's STI testing pattern. Further studies are required to explore how trust in media might promote STI testing in this population.
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Affiliation(s)
- Ana Paula Finatto Canabarro
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden
| | - Malin Eriksson
- Department of Social Work, Umeå University, 901 87, Umeå, Sweden
| | - Anna Nielsen
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden
| | - Zangin Zeebari
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden
- Jönköping International Business School, Jönköping University, Gjuterigatan 5, 553 18, Jönköping, Sweden
| | - Mariano Salazar
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden
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18
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Metz G, Roosjen H, Zweers W, Crutzen R. Evaluating use of web-based interventions: an example of a Dutch sexual health intervention. Health Promot Int 2023; 38:daab190. [PMID: 37596929 PMCID: PMC10439511 DOI: 10.1093/heapro/daab190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
With the current increase in web-based interventions, the question of how to measure, and consequently improve engagement in such interventions is gaining more importance. Modern day web analytics tools make it easy to monitor use of web-based interventions. However, in this article, we propose that it would be more meaningful to first examine how the developers envisioned the use of the intervention to establish behavior change (i.e. intended use), before looking into how the intervention is ultimately used with web analytics (i.e. actual use). Such an approach responds to the regularly expressed concern that behavioral interventions are often poorly described, leading to less meaningful evaluations as it is not clear what exactly is being evaluated. Using a page on chlamydia prevention (104 557 pageviews in 2020) from a Dutch sexual health intervention (Sense), we demonstrate the value of acyclic behavior change diagrams (ABCDs) as a method to visualize intended use of an intervention. ABCDs show at a glance how behavior change principles are applied in an intervention and target determinants of behavior. Based on this ABCD, we investigate actual use of the intervention, using web analytics tool Matomo. Despite being intended to stimulate STI-testing, only 14% of the 35 347 transfers from this page led to the STI-testing page and a high bounce rate (79%) and relatively high exit rate were reported (69%). Recommendations to further interpret the data are given. This real-life example demonstrates the potential of combining ABCDs and Matomo as methods to gain insight into use of web-based interventions.
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Affiliation(s)
- Gido Metz
- Department of Health Promotion, Maastricht University/CAPHRI, The Netherlands
| | | | | | - Rik Crutzen
- Department of Health Promotion, Maastricht University/CAPHRI, The Netherlands
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19
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Smith MS, South SC. Risky Sexual Behaviors as a Transaction of Individual Differences and Situational Context. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2539-2560. [PMID: 37103633 DOI: 10.1007/s10508-023-02592-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 02/21/2023] [Accepted: 03/19/2023] [Indexed: 06/19/2023]
Abstract
Risky sexual behaviors (RSBs) incur large societal and personal costs. Despite widespread prevention efforts, RSBs and associated consequences (e.g., sexually transmitted infections) continue to rise. A proliferation of research has emerged on situational (e.g., alcohol use) and individual difference (e.g., impulsivity) factors to explain this rise, but these approaches assume an unrealistically static mechanism underlying RSB. Because this prior research has resulted in few compelling effects, we sought to innovate by examining the interaction of situation and individual differences in explaining RSBs. A large sample (N = 105) completed baseline reports of psychopathology and 30 daily diary reports of RSBs and associated contexts. These data were submitted to multilevel models including cross-level interactions to test a person-by-situation conceptualization of RSBs. Results suggested that RSBs are most strongly predicted from interactions of person- and situation-level factors in both protective and facilitative directions. These interactions outnumbered main effects and commonly included partner commitment as a central mechanism. These results point to theoretical and clinical gaps in preventing RSB and urge a departure from prior ways of conceptualizing sexual risk as a static outcome.
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Affiliation(s)
- Madison Shea Smith
- Department of Psychological Sciences, Purdue University, 703 3rd Street, West Lafayette, IN, USA.
| | - Susan C South
- Department of Psychological Sciences, Purdue University, 703 3rd Street, West Lafayette, IN, USA
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20
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Camino AF, Whitfield M, Pridgen K, Van Der Pol B, Van Wagoner N. Embedding a Dedicated Sexual Health Clinic in a University's Health Services Expands Sexually Transmitted Infection Screening Options. Sex Transm Dis 2023; 50:462-466. [PMID: 36943784 PMCID: PMC10272105 DOI: 10.1097/olq.0000000000001804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND The primary objectives of this study were to assess utilization of sexual health services at a university's student health and wellness center and to determine whether the presence of a dedicated sexual health clinic (SHC) was associated with different utilization patterns for sexual health services when compared with primary care clinics. METHODS This was a retrospective chart review of patients presenting to the University of Alabama at Birmingham's Student Health and Wellness Center for sexual health services between January 2015 and June 2019. Utilization of sexual health services, specifically sexually transmitted infection (STI) testing, was compared between the dedicated SHC and primary care clinics. RESULTS A total of 3081 cases were included. There were statistically significant differences in the proportion of male individuals and populations more burdened by STI tested for STI in the SHC (i.e., persons who identify as Black and younger female individual). We also observed a higher percentage of positive gonorrhea and chlamydia test results and a greater likelihood of extragenital screening in men who have sex with men in the SHC. CONCLUSIONS The dedicated SHC within the University of Alabama at Birmingham's Student Health and Wellness Center was associated with an increase in STI screenings. There was a significant difference between the demographics of those presenting to the SHC versus primary care clinics, proportionally more diagnoses of gonorrhea and chlamydia, and, for men who have sex with men, more extragenital screenings performed in the SHC. These findings suggest that there may be a benefit of an embedded SHC in college and university health and wellness centers.
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Affiliation(s)
- Andres F Camino
- From the University of Alabama at Birmingham Heersink School of Medicine
| | | | | | - Barbara Van Der Pol
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Nicholas Van Wagoner
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
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21
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Reingold S, Tomcho M, Thomas-Gale T, Haynes C, O'Leary S, Warsh S, Rinehart D, Frost H. Survey of Adolescents' and Emerging Adults' Preferences for Gonorrhea and Chlamydia Testing in Primary Care. Sex Transm Dis 2023; 50:320-322. [PMID: 36649601 DOI: 10.1097/olq.0000000000001773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
ABSTRACT Our study assessed adolescents' and emerging adults' (ages 14-24 years) preferences for opt-out gonorrhea and chlamydia screening compared with risk-based screening. Most participants (93%) preferred opt-out gonorrhea and chlamydia testing compared with risk-based testing (6%), and opt-out testing was associated with less sexually transmitted infection-related stigma ( P < 0.05).
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22
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Nelson KM, Skinner A, Stout CD, Raderman W, Unger E, Raifman J, Agénor M, Ybarra ML, Dunsiger SI, Bryn Austin S, Underhill K. Minor Consent Laws for Sexually Transmitted Infection and Human Immunodeficiency Virus Services in the United States: A Comprehensive, Longitudinal Survey of US State Laws. Am J Public Health 2023; 113:397-407. [PMID: 36730879 PMCID: PMC10003504 DOI: 10.2105/ajph.2022.307199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 02/04/2023]
Abstract
Objectives. To assess changes in minor consent laws for sexually transmitted infection (STI) and HIV testing, treatment, and prevention services in all 50 US states and the District of Columbia from 1900 to 2021. Methods. We coded laws into minor consent for (1) health care generally; (2) STI testing, treatment, and prevention; (3) HIV testing, treatment, and prevention; and (4) pre- or postexposure prophylaxis for HIV prevention. We also coded confidentiality protections and required conditions (e.g., threshold clinician judgments). Results. The largest increase in states allowing minors to consent to STI services occurred during the 1960s and 1970s. By 2021, minors could consent independently to STI and HIV testing and treatment in all 50 states plus DC, STI prevention services in 32 jurisdictions, and HIV prevention services in 33 jurisdictions. Confidentiality protections for minors are rare. Prerequisites are common. Conclusions. Although the number of states allowing minors to consent independently to STI and HIV services has increased considerably, these laws have substantial limitations, including high complexity, prerequisites requiring clinician judgments, and neglect of confidentiality concerns. (Am J Public Health. 2023;113(4):397-407. https://doi.org/10.2105/AJPH.2022.307199).
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Affiliation(s)
- Kimberly M Nelson
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Alexandra Skinner
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Claire D Stout
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Will Raderman
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Emily Unger
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Julia Raifman
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Madina Agénor
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Michele L Ybarra
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Shira I Dunsiger
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - S Bryn Austin
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
| | - Kristen Underhill
- Kimberly M. Nelson and Claire D. Stout are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Alexandra Skinner, Will Raderman, and Julia Raifman are with the Department of Health Law, Policy, and Management, Boston University School of Public Health. Emily Unger and S. Bryn Austin are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Madina Agénor and Shira I. Dunsiger are with the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI. Michele L. Ybarra is with the Center for Innovative Public Health Research, San Clemente, CA. Kristen Underhill is with Cornell Law School, Ithaca, NY
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23
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Wright PJ, Tokunaga RS, Herbenick D, Paul B. Pornography, Sexual Insecurity, and Orgasm Difficulty. HEALTH COMMUNICATION 2023; 38:552-561. [PMID: 34323637 DOI: 10.1080/10410236.2021.1958985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
While recent meta-analyses have provided answers to a number of historically contentious debates about correlates of pornography use, several questions remain unanswered. Whether pornography is associated with sexual functioning is one such question. Informed by theorizing on sexual scripting, social comparisons, and sexual objectification, the present study examined the possibility that pornography is related to orgasm difficulty through sexual insecurity (i.e., insecurity about one's sexual performance and sexual attractiveness). Data were from the National Survey of Porn Use, Relationships, and Sexual Socialization (NSPRSS), a U.S. population-based probability study. There was an indirect effect of pornography consumption frequency on orgasm difficulty through sexual insecurity. Participants who used pornography more frequently reported higher levels of sexual insecurity, and higher levels of sexual insecurity predicted orgasm difficulty. There was also an indirect effect of partner pressure to view pornography on orgasm difficulty. Higher levels of partner pressure to view pornography were associated with higher levels of sexual insecurity, which in turn predicted orgasm difficulty. Results were indistinguishable by gender and maintained after controlling for a number of potential confounds. These findings suggest that some men and women's personal and (pressured) partnered pornography consumption have the potential to increase orgasm difficulty through bodily and performance insecurity.
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Affiliation(s)
| | | | - Debby Herbenick
- The Center for Sexual Health Promotion, the School of Public Health, Indiana University
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Reeves JM, Zigah EY, Shamrock OW, Aidoo-Frimpong G, Dada D, Batten J, Abu-Ba'are GR, Nelson LE, Djiadeu P. Investigating the impact of stigma, accessibility and confidentiality on STI/STD/HIV self-testing among college students in the USA: protocol for a scoping review. BMJ Open 2023; 13:e069574. [PMID: 36792328 PMCID: PMC9933744 DOI: 10.1136/bmjopen-2022-069574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION In 2019, there were 2.5 million reported cases of chlamydia, gonorrhoea and syphilis. The Centers for Disease Control and Prevention reported in the USA, young people aged 15-24 made up 61% and 42% of chlamydia and gonorrhoea cases, respectively. Moreover, the highest rates of sexually transmitted infections (STIs) were reported among college-aged students. In this paper, we outline our protocol to systematically review the published literature on, the use of STI/HIV self-test kits, increasing STI/HIV testing uptake, and stigma, access and confidentiality issues, among young adult college students in the USA. METHODS AND ANALYSIS This scoping review will be conducted and reported according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We will search electronic databases, OVID Medline, OVID Embase, Web of Science, Cochrane Library, PubMed and CINAHL, for articles published in English from inception to the present. We will search other alternative sources such as ProQuest, Google Scholar and Google to identify grey literature. A two-step process will be used to identify eligible studies based on the defined inclusion criteria. First, the title and abstract of identified articles will be screened for possible inclusion. Second, full-text articles of relevant studies will be retrieved and screened for inclusion. Both screening steps will be done by two people independently. Finally, data will be extracted by two researchers working independently. Any arising disagreements will be resolved by consensus or by a third author. ETHICS AND DISSEMINATION This study is a scoping review of the literature. Therefore, ethics approval is not required. Our plan for the dissemination of findings includes peer-reviewed manuscripts, conferences and webinars.
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Affiliation(s)
- Jaquetta M Reeves
- College of Nursing and Health Innovation, The University of Texas Arlington, Arlington, Texas, USA
| | - Edem Yaw Zigah
- School of Nursing, University of Rochester, Rochester, New York, USA
| | - Osman W Shamrock
- School of Nursing, University of Rochester, Rochester, New York, USA
| | - Gloria Aidoo-Frimpong
- Center Interdisciplinary Research on AIDS, Yale University School of PublicHealth, New Haven, Connecticut, USA, New Haven, Connecticut, USA
| | - Debbie Dada
- School of Nursing, Yale University, New Haven, Connecticut, USA
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Janene Batten
- Medical Library, Yale University, Harvey Cushing/John Hay Whitney Medical Library, New Haven, Connecticut, USA
| | - Gamji R Abu-Ba'are
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
- School of Nursing, Behavioral, Sexual, and Global Health Lab, University of Rochester, Rochester, New York, USA
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, Connecticut, USA
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Pascal Djiadeu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Health Research Methods Evidence and Impact, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
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Disparities in Sexually Transmitted Infection/HIV Testing, Contraception, and Emergency Contraception Care Among Adolescent Sexual Minority Women Who Are Racial/Ethnic Minorities. J Adolesc Health 2023; 72:214-221. [PMID: 36369111 DOI: 10.1016/j.jadohealth.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Sexual minority women and racial/ethnic minority women in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy. Yet, we know little about STI/HIV testing and contraceptive care among women who have sex with women only and women who have sex with both women and men, and who are racial/ethnic minorities. This study examined receipt of STI/HIV testing and contraceptive care among sexually active adolescent women by sex of sexual contact(s) and race/ethnicity. METHODS Our sample included 2,149 sexually active adolescent women from the National Survey of Family Growth (2011-2019). We examined receipt of sexual and reproductive health (SRH) services by sex of sexual contact(s) and race/ethnicity: STI and HIV testing, contraceptive counseling, contraceptive method, emergency contraception (EC) counseling, and EC method. RESULTS Service receipt was low for all adolescent women, with disparities by sex of sexual contact(s) and by race/ethnicity. Women who have sex with women only had the lowest rates across all services; women who have sex with both women and men had higher rates of STI and HIV testing and EC counseling than women who have sex with men only. Non-Hispanic Black women had higher rates of STI and HIV testing than non-Hispanic White peers, and non-Hispanic Black and Hispanic women had lower rates of contraception method receipt than their non-Hispanic White peers. Racial/ethnic disparities persisted when results were stratified by sex of sexual contact(s). DISCUSSION There is an unmet need for improved SRH service delivery for all adolescent women and for services that are not biased by sex of sexual contact(s) and race/ethnicity.
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Mozingo SL, Museck IJ, Mitchell SE, Sherman EC, Claypool NA, Gizzi KA, King BM. Students' awareness of the student health center's sexual health services at a southeast public university. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:76-79. [PMID: 33577422 DOI: 10.1080/07448481.2021.1876707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/27/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
Objective: To determine whether university students are aware of the sexual health services offered by the student health center. Participants: 522 undergraduate students at a southeast public university. Methods: Students were given a list of 19 sexual health services and tests and were instructed that for each one to check "offered," "not offered," or "I'm not sure." Results: Students were generally unaware that the health center offered testing for a variety of sexually transmitted infections (13-27.4% aware), the Gardasil vaccine for human papillomavirus (HPV) (15.5% aware), the IUD (8.8% aware), emergency contraception (18.6% aware), and breast (24.9% aware) and pelvic examinations (16.5% aware). The only exceptions were for free male condoms (63% aware) and women's awareness of birth control pills (55.3% aware) and pregnancy testing (50.3% aware). Nearly half the students were not aware that parents/guardians could not obtain health center medical records without the student's permission. Conclusions: Student health centers cannot be effective in reducing unwanted pregnancies and the spread of STIs if students are unaware of the services provided. Health centers must do a better job of educating students.
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Affiliation(s)
- Shelby L Mozingo
- Honors College and Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Isabelle J Museck
- Honors College and Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Sara E Mitchell
- Honors College and Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Emma C Sherman
- Honors College and Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Natalie A Claypool
- Honors College and Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Katherine A Gizzi
- Honors College and Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Bruce M King
- Honors College and Department of Psychology, Clemson University, Clemson, South Carolina, USA
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Hojilla JC, Sarovar V, Lam JO, Park IU, Vincent W, Hare CB, Silverberg MJ, Satre DD. Sexually Transmitted Infection Screening in Key Populations of Persons Living with HIV. AIDS Behav 2023; 27:96-105. [PMID: 35916949 PMCID: PMC9851927 DOI: 10.1007/s10461-022-03747-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 01/24/2023]
Abstract
Annual screening for bacterial sexually transmitted infections (STI), including gonorrhea/chlamydia (GC/CT) and syphilis, is recommended for persons with HIV (PWH). We used the prevention index to quantify the extent to which STI screening was completed at guideline-recommended frequency in African American and Latinx persons, women, persons with alcohol (AUD) and substance (SUD) use disorders. Data from PWH at Kaiser Permanente Northern California were collected from electronic health records. We defined receipt of GC/CT and syphilis screening consistent with recommendations as a prevention index score ≥ 75%. Among 9655 PWH (17.7% Latinx; 16.2% African American; 9.6% female; 12.4% AUD; 22.1% SUD), prevention index scores for GC/CT and syphilis increased from 2015 to 2019. African American PWH had lower odds of receiving an annual syphilis screen (aOR 0.87 [95% CI 0.79-0.97]). Female sex was associated with lower odds of GC/CT (aOR 0.30 [95% CI 0.27-0.34]) and syphilis (aOR 0.27 [95% CI 0.24-0.310) screening. AUD and SUD were not associated with differences in annual GC/CT or syphilis screening. Key PWH subgroups experience ongoing challenges to annual STI screening despite comparable healthcare access.
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Affiliation(s)
- J Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Ina U Park
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States
| | - Wilson Vincent
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - C Bradley Hare
- Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United States
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
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Underhill K, Nelson KM. Consent Laws for Minors Regarding Sexually Transmitted Infection and HIV Services-Reply. JAMA 2022; 328:2364. [PMID: 36538312 PMCID: PMC10316674 DOI: 10.1001/jama.2022.19040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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Lopez E, Bell D. Comprehensive Sexually Transmitted Infection Screening and Testing Interventions in a Predominantly Heterosexual Population with HIV at a Health Center. AIDS Patient Care STDS 2022; 36:111-116. [PMID: 36178407 DOI: 10.1089/apc.2022.0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In the United States, sexually transmitted infections (STIs) have remained elevated for the fifth consecutive year from 2015 to 2019. There is a need to implement standardization of the US Centers for Disease Control and Prevention STI screening and testing recommendations. Higher STI incidence populations such as people with HIV, men who have sex with men, and adolescents and young adults, are frequently not screened and tested for bacterial STIs as recommended. Federally qualified health centers (FQHCs) have the potential to deliver STI services for at-risk individuals as a routine component of primary care. Comprehensive sexual histories using audio computer-assisted self-interview software on electronic devices were done at each clinic visit at a FQHC. Extragenital site testing for chlamydia and gonorrhea, and blood drawn for syphilis testing was completed onsite based on the sexual history responses. Out of 432 eligible clients, 230 clients consented to having their data used for evaluation in this study. Sexual orientation was reported as heterosexual or straight by 86.5% (n = 199), 10.9% (n = 25) as gay/lesbian/same-sex loving, and 2.6% (n = 6) as bisexual or pansexual. Specimen collection took place over a 16-month period and included 80% (n = 855) urine, 13% (n = 140) pharyngeal, and 6.4% (n = 68) rectal samples. Positivity rates included 10% (n = 7) rectal, 6% (n = 8) pharyngeal, and 2% (n = 20) urine samples. Findings identified higher positivity rates among pharyngeal and rectal specimens compared to urogenital specimens. The feasibility of implementing a comprehensive STI screening and testing process in a FQHC is attainable and beneficial.
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Affiliation(s)
- Eloisa Lopez
- Medical and Dental, Care South, Baton Rouge, Louisiana, USA
| | - Dionne Bell
- Medical and Dental, Care South, Baton Rouge, Louisiana, USA
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30
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Hunt JA, Randell KA, Mermelstein S, Miller MK, Masonbrink AR. Understanding the Sexual and Reproductive Health Needs of Hospitalized Adolescent Males. Hosp Pediatr 2022; 12:e387-e392. [PMID: 36300339 PMCID: PMC9647630 DOI: 10.1542/hpeds.2021-006489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe sexual behaviors and acceptability of receiving sexual and reproductive health (SRH) services among hospitalized adolescent males. METHODS We performed a cross-sectional survey of hospitalized adolescents. Eligible participants were males aged 14 to 20 years admitted at 2 academic medical centers. Outcome measures included reported healthcare utilization, sexual health behaviors (eg, sexual activity), contraception use, and acceptability of SRH discussions during a hospitalization. RESULTS Among 145 participants, 42% reported a history of vaginal sex, 27% current sexual activity, 12% early sexual debut, and 22% 4 or more prior sexual partners. At last sex, condom use was reported by 63% and use of reversible contraception by 36%. Nearly half (45%) agreed that hospital-based SRH discussions were acceptable, particularly among those with history of sexual activity (P < .01). Some (12%) reported they had not accessed care in the past year when they felt they should. CONCLUSIONS Hospitalized males in our study had similar rates of sexual activity as compared with the general population but had higher rates of early sexual debut and number of prior partners, which are independently linked with negative sexual health outcomes (eg, sexually transmitted infections). Our participants found SRH discussions to be generally acceptable. These findings reveal opportunities to screen for unmet SRH needs and provide SRH education and services for adolescent males in the hospital.
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Affiliation(s)
- Jane Alyce Hunt
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Kimberly A Randell
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Sarah Mermelstein
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Melissa K Miller
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Abbey R Masonbrink
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- University of Kansas School of Medicine, Kansas City, Kansas
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Patterns in Receipt and Source of STI Testing Among Young People in the United States, 2013-2019. J Adolesc Health 2022; 71:642-645. [PMID: 35691850 DOI: 10.1016/j.jadohealth.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Rates of sexually transmitted infections (STIs) among adolescents and young adults (15-24) continue to increase. Limited national information exists about the frequency and source of STI testing among this population. METHODS We performed a cross-sectional analysis of National Survey of Family Growth data from 2013-2019 to describe patterns in STI testing and assess associations with individual characteristics. RESULTS We found that non-Hispanic Black women, non-Hispanic Black and Hispanic men, and individuals with public insurance are more likely to receive an STI test. The two sexes have different sources of care for STI testing and publicly supported providers provide the bulk of services to marginalized populations. DISCUSSION STI testing frequencies of this age group fall below what national guidelines suggest. Multiple socioecological factors may affect the likelihood that a young person receives an STI test. All providers should be supported and encouraged to provide confidential and unbiased STI care.
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Teixeira da Silva D, Petsis D, Santos T, Mahajan A, Bonett S, Wood S. Chlamydia Trachomatis/Neisseria Gonorrhea Retesting Among Adolescents and Young Adults in a Primary Care Network. J Adolesc Health 2022; 71:545-551. [PMID: 35963759 PMCID: PMC9588690 DOI: 10.1016/j.jadohealth.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/12/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Chlamydia trachomatis/Neisseria gonorrhea (CT/NG) retesting three months after diagnosis is a guideline-recommended strategy to detect re-infections. Adolescents and young adults are priority populations in the U.S. Sexually Transmitted Infections National Strategic Plan, but there is a lack of research examining CT/NG retesting among these populations. This study describes retesting following CT/NG diagnosis among adolescent and young adult patients at Title X and non-Title X clinics and measures the association of patient-level factors with CT/NG retesting. METHODS We evaluated electronic medical records from 2014 to 2020 from an academic urban-suburban primary care network. The primary outcome was retesting, defined as a diagnostic test for CT or NG ordered 8-16 weeks after index diagnosis. Mixed effects logistic regression modeling stratified by Title X funding was conducted to evaluate the association of patient-level factors with CT/NT retesting. RESULTS Overall, 23.5% (n = 731) of patients were retested within 8-16 weeks following index CT/NG diagnosis. A significantly greater proportion of Title X patients were retested compared to non-Title X patients. Males were significantly less likely to be retested compared to females, and the proportion of patients retested decreased significantly over the study period. DISCUSSION Guideline-recommended retesting following CT/NG diagnosis was low in this young primary care cohort, especially among male and non-Title X clinic patients. Decreases in CT/NG retesting over the study period may be contributing to worsening of the STI epidemic. Our results provide insights into CT/NG retesting that can inform efforts to end the STI epidemic.
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Affiliation(s)
- Daniel Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Danielle Petsis
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tatiane Santos
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anjali Mahajan
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephen Bonett
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Wood
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Bibriescas N, Wainwright K, Thomas R, Lopez V, Romanowich P. Differential relationships between discount rates and health behaviors in an ethnically diverse college sample. Front Public Health 2022; 10:943499. [PMID: 36016889 PMCID: PMC9396243 DOI: 10.3389/fpubh.2022.943499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/22/2022] [Indexed: 01/21/2023] Open
Abstract
Previous research has demonstrated associations between delay discount rate and engagement in several health behaviors. The delay discount rate is also inversely associated with social discount rates, a putative measure for sharing. However, there is little research that examines whether delay and social discount rates are differentially associated with health behavior engagement, and even less research examining the impact of ethnicity on these relationships. This study investigated whether delay and/or social discount rates predict three health behaviors varying in sociality: sexually transmitted infection (STI) testing, alcohol consumption and exercise frequency in an ethnically diverse university sample. The results showed that neither delay nor social discount rate significantly predicted alcohol consumption and exercise frequency. However, increasing social discount rates (i.e., decreased sharing) was associated with a decreased likelihood to be tested for STIs. Ethnicity significantly contributed to two models, indicating differences in STI testing and alcohol consumption across ethnicities. Ethnic differences in these health behaviors were consistent with many previous health behavior studies, suggesting a profitable way to research cultural contingencies and test the reliability of the ethnically diverse data. These findings indicate that the social discount rate is differentially associated with health behaviors with more social aspects (i.e., health behaviors related to sex) in college students.
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Affiliation(s)
- Natashia Bibriescas
- Department of Educational Psychology, The University of Texas at Austin, Austin, TX, United States
| | - Katherine Wainwright
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Rebecca Thomas
- Ecampus Research Unit, Oregon State University, Corvallis, OR, United States
| | - Victoria Lopez
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Paul Romanowich
- Department of Psychology, Gonzaga University, Spokane, WA, United States,*Correspondence: Paul Romanowich
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Lindley LL, Sharif AM, Chowdhury T. College students' comfort with and intention to use self-collection services for STI testing. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1768-1777. [PMID: 33048627 DOI: 10.1080/07448481.2020.1820511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/10/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Objective: Sexually transmitted infections (STIs) are at unprecedented levels; yet most college students have never been tested. Offering asymptomatic individuals the option to collect their own samples for STI testing is an effective strategy to increase testing coverage. This study explores students' perceptions of self-collection services. Participants: Four hundred and thirty-four (434) students from a large public university completed an online survey in February 2018. Methods: The cross-sectional survey assessed students' human immunodeficiency virus (HIV)/STI testing behaviors, comfort with self-collection procedures, and intention to use self-collection services if offered on campus. Results: Most students (88%) said they would use self-collection test kits they could take home, followed by self-collection in a private room at student health services (59%). Students were most comfortable with testing procedures involving less human interaction and collecting specimens themselves. Cost, accuracy, confidentiality of tests, and provision of clear "how to" instructions, topped students' concerns. Conclusion: Offering self-collection options may increase STI testing among asymptomatic college students.
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Affiliation(s)
- Lisa L Lindley
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - A'isha M Sharif
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Tasnuva Chowdhury
- UCSD COVID Team, Department of Medicine, University of California San Diego, San Diego, California, USA
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35
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de Wit JBF, Adam PCG, den Daas C, Jonas K. Sexually transmitted infection prevention behaviours: health impact, prevalence, correlates, and interventions. Psychol Health 2022; 38:675-700. [PMID: 35748408 DOI: 10.1080/08870446.2022.2090560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sexually transmitted infections (STIs) remain a major public health threat, disproportionately affecting young people, and men who have sex with men. In this narrative review of the current state of behavioural science research on STI prevention, we consider the definition, health impacts, correlates and determinants, and interventions to promote STI prevention behaviour. Research on STI prevention behaviour has extended from a focus on abstinence, partner reduction and condom use, to also include novel preventive behaviours, notably treatment-as-prevention, pre-exposure prophylaxis (i.e., the preventive use of medicines by uninfected people), and vaccination for some STIs. Social-cognitive factors specified by, for instance the theory of planned behaviour, are critical proximal determinants of STI prevention behaviours, and related interventions can effectively promote STI prevention behaviours. Social-ecological perspectives highlight that individual-level determinants are embedded in more distal environmental influences, with social stigma especially affecting STI prevention behaviours and requiring effective intervention. Further to providing a major domain of application, STI prevention also poses critical challenges and opportunities for health psychology theory and research. We identify a need for health behaviour theory that addresses the processes linking multiple levels of influence on behaviour and provides practical guidance for multi-level behaviour change interventions adapted to specific contexts.
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Affiliation(s)
- John B. F. de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | - Philippe C. G. Adam
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
- Institute for Prevention and Social Research, Bangkok, Thailand
| | - Chantal den Daas
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
| | - Kai Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
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36
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Russell NG, Sharps PW, Sloand E. Web‐based
chlamydia education for university students: A pilot project. Nurs Open 2022; 9:2342-2347. [PMID: 35643961 PMCID: PMC9374413 DOI: 10.1002/nop2.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/13/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
Aims Chlamydia disproportionately affects individuals aged 15–24 years. A lack of chlamydia knowledge in this high‐risk group likely contributes to decreased testing, but interventions to increase chlamydia knowledge in this population are not well‐described in the literature. The purpose of this pilot project was to increase chlamydia knowledge in a sample of university students using nurse‐developed web‐based education. Design A pre‐ and post‐test design was used to evaluate participant knowledge of chlamydia before and after completing a nurse‐developed web‐based education intervention designed for university students. Methods Forty‐seven undergraduate students at one U.S. university participated. A focus group and scientific evidence informed the development of the web‐based education. Results Participants had a significant increase in chlamydia knowledge after completing the online educational intervention (M = 8.0, SD = 0.000) compared to baseline (M = 6.5, SD = 1.5), t(33) = −5.821, p < .0001. Pilot results provide promising evidence that web‐based nurse‐developed education designed specifically for university students can increase chlamydia knowledge.
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Affiliation(s)
- Nancy G. Russell
- Georgetown University Washington District of Columbia USA
- Johns Hopkins School of Nursing Baltimore Maryland USA
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Liddon N, Pampati S, Dunville R, Kilmer G, Steiner RJ. Annual STI Testing Among Sexually Active Adolescents. Pediatrics 2022; 149:186749. [PMID: 35403192 PMCID: PMC9126309 DOI: 10.1542/peds.2021-051893] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES National guidelines call for annual testing for certain sexually transmitted infections (STIs) among specific adolescent populations, yet we have limited population-based data on STI testing prevalence among adolescents. With inclusion of a new item in the 2019 national Youth Risk Behavior Survey, we provide generalizable estimates of annual STI testing among sexually active high school students. METHODS We report weighted prevalence estimates of STI testing (other than HIV) in the past 12 months among sexually active students (n = 2501) and bivariate associations between testing and demographic characteristics (sex, age, race and ethnicity, sexual identity, and sex of sexual contact). Multivariable models stratified by sex and adjusted for demographics examine the relationships between testing and sexual behaviors (age of initiation, number of sex partners, condom nonuse at last sexual intercourse, and substance use at last sexual intercourse). RESULTS One-fifth (20.4%) of sexually active high school students reported testing for an STI in the previous year. A significantly higher proportion of female (26.1%) than male (13.7%) students reported testing. Among female students, prevalence differed by age (≤15 years = 12.6%, age 16 = 22.8%, age 17 = 28.5%, or ≥18 years = 36.9%). For male students, there were no differences by demographic characteristics, including sexual identity, but most sexual risk behaviors were associated with increased likelihood of STI testing (adjusted prevalence ratios ranging from 1.48 to 2.47). CONCLUSIONS Low prevalence of STI testing suggests suboptimal adherence to national guidelines, particularly for sexually active adolescent females and young men who have sex with men who should be tested for Chlamydia and gonorrhea annually.
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Affiliation(s)
| | - Sanjana Pampati
- Divisions of Adolescent and School Health,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | | | | | - Riley J Steiner
- Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Eastman-Mueller H, Fu TC, Dodge BM, Herbenick D. The relationship between college students' campus sexual health resource utilization and self-reported STI testing: Findings from an undergraduate probability survey. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:843-851. [PMID: 32569499 DOI: 10.1080/07448481.2020.1775607] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 04/22/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveTo examine the prevalence of student utilization of campus sexual health resources and their association with sexually transmitted infection (STI) testing. Participants: Undergraduate students (n = 7020) at a large Midwestern university completed a confidential online survey in 2015. Methods: A probability-based sample of undergraduate students completed a cross-sectional online survey. Results: Commonly accessed sexual health resources were student orientation activities about sexual assault or rape, sexuality/gender classes, gender and sexual orientation panels, class panels on sexual assault, birth control and STI presentations, and having joined a sexuality-related student organization. Campus sexual health resource utilization was significantly associated with greater STI testing since college. Gender, race, class level, enrollment status, sexual orientation, timing of last sexual event, and perceived STI risk were significantly associated with STI testing in college. Conclusions: Campus sexual health resources play an important role in student sexual health promotion.
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Affiliation(s)
- Heather Eastman-Mueller
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
- Indiana University Health Center, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Tsung-Chieh Fu
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Brian M Dodge
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Debby Herbenick
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
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Renfro KJ, Haderxhanaj L, Coor A, Eastman-Mueller H, Oswalt S, Kachur R, Habel MA, Becasen JS, Dittus PJ. Sexual-risk and STI-testing behaviors of a national sample of non-students, two-year, and four-year college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:544-551. [PMID: 32407180 PMCID: PMC10477969 DOI: 10.1080/07448481.2020.1756830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/28/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine whether sexual-risk and STI-testing behaviors differ by college student status. PARTICIPANTS Sexually experienced 17- to 25-year-olds from a 2013 nationally representative panel survey that evaluated the "Get Yourself Tested" campaign. Non-students (n = 628), 2-yr (n = 319), and 4-yr college students (n = 587) were surveyed. METHODS Bivariate analyses and multiple logistic regression were used. RESULTS Students were less likely than non-students to have had an early sexual debut and to have not used condoms in their most recent relationship. 4-yr students were less likely than non-students to have had multiple sexual partners. 2-yr students were less likely than non-students to have not used contraception in their most recent relationship. CONCLUSIONS 2-yr and 4-yr college students were less likely than non-students to engage in sexual-risk behaviors. Given potentially greater risk for STI acquisition among non-students, identification and implementation of strategies to increase sexual health education and services among this population is needed.
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Affiliation(s)
- Kaytlin J. Renfro
- Oak Ridge Institute for Science and Education, Atlanta, Georgia, USA
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Haderxhanaj
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexandra Coor
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heather Eastman-Mueller
- Department of Applied Health Science, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Sara Oswalt
- Department of Public Health, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Rachel Kachur
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa A. Habel
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Patricia J. Dittus
- Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Allison BA, Park RV, Walters EM, Perry MF. Increased Detection of Gonorrhea and Chlamydia After Implementation of a Universal Screening Protocol in a Pediatric Primary Care Clinic. Sex Transm Dis 2022; 49:117-122. [PMID: 34407011 PMCID: PMC8881983 DOI: 10.1097/olq.0000000000001534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Literature suggests that adolescents may not accurately report sexual activity to their providers, impeding risk-based screening efforts for gonorrhea and chlamydia (GC/CT). We assessed the effect of a clinic-based universal GC/CT screening initiative on GC/CT screening frequency and detection of GC/CT infections among adolescents (boys and girls ≥13 years) and the association between positive GC/CT and documented sexual activity. METHODS We conducted a pre-post analysis of a primary care clinic affiliated with an academic institution. The electronic medical record was queried to extract all adolescent well and acute encounters for the 12 months preimplementation and postimplementation of universal GC/CT screening in January 2015. RESULTS Eight hundred fifty-six encounters from 752 unique adolescents were included. Screening increased postimplementation (23.3% vs 61.4%, P < 0.001) of universal screening. Although there were similar rates of documented sexual activity preimplementation and postimplementation (14.6% vs 16.0%), a larger proportion of unknown sexual activity was documented (10.5% vs 23.7%, P < 0.001). Provider-level factors were the most frequent reasons for not screening. The absolute number of GC/CT cases increased, although the proportion of cases out of all eligible adolescents remained similar as more testing was completed (chlamydia, 5 of 752 vs 12 of 752; P = 0.09; gonorrhea, 0 of 752 vs 1 of 752; P = 0.32). Nearly half of positive chlamydia infections postimplementation appeared in adolescents who reported no sexual activity. CONCLUSIONS Universal screening in a primary care clinic increased screening and detection of cases of gonorrhea and chlamydia, including in adolescents who did not report sexual activity.
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Affiliation(s)
| | | | - Elizabeth M Walters
- University of North Carolina School of Nursing, Carrington Hall, Chapel Hill, NC
| | - Martha F Perry
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
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Wood S, Min J, Tam V, Pickel J, Petsis D, Campbell K. Inequities in Chlamydia trachomatis Screening Between Black and White Adolescents in a Large Pediatric Primary Care Network, 2015-2019. Am J Public Health 2022; 112:135-143. [PMID: 34936422 PMCID: PMC8713640 DOI: 10.2105/ajph.2021.306498] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 01/03/2023]
Abstract
Objectives. To identify associations between patient race and annual chlamydia screening among adolescent females. Methods. We performed a retrospective cohort study of females aged 15 to 19 years in a 31-clinic pediatric primary care network in Pennsylvania and New Jersey from 2015 through 2019. Using mixed-effect logistic regressions, we estimated associations between annual chlamydia screening and patient (race/ethnicity, age, previous chlamydia screening and infection, insurance type) and clinic (size, setting) characteristics. We decomposed potential effects of clinician's implicit racial bias and screening, using covariates measuring the proportion of Black patients in each clinician's practice. Results. There were 68 935 well visits among 37 817 females, who were 28.8% Black and 25.8% Medicaid insured. The mean annual chlamydia screening rate was 11.1%. Black females had higher odds of screening (adjusted odds ratio [AOR] = 1.67; 95% confidence interval [CI] = 1.51, 1.84) than did White females. In the clinician characteristics model, individual clinicians were more likely to screen their Black versus non-Black patients (AOR = 1.88; 95% CI = 1.65, 2.15). Conclusions. Racial bias may affect screening practices and should be addressed in future interventions, given the critical need to increase population-level chlamydia screening.(Am J Public Health. 2022;112(1):135-143. https://doi.org/10.2105/AJPH.2021.306498).
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Affiliation(s)
- Sarah Wood
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Jungwon Min
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Vicky Tam
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Julia Pickel
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Danielle Petsis
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Kenisha Campbell
- Sarah Wood and Danielle Petsis are with the PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA. Jungwon Min and Vicky Tam are with the Department of Biostatistics and Health Informatics, Children's Hospital of Philadelphia. Julia Pickel is with the Wake Forest School of Medicine, Winston-Salem, NC. Kenisha Campbell is with the Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia
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Brittain AW, Steiner RJ, Fasula AM, Hatfield-Timajchy K, Kulkarni A, Koumans EH. Improving Access to and Quality of Sexual and Reproductive Health Services for Adolescents in the United States. J Womens Health (Larchmt) 2022; 31:7-12. [PMID: 35023768 PMCID: PMC10961097 DOI: 10.1089/jwh.2021.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Equitable access to high quality adolescent sexual and reproductive health (ASRH) services can help reduce unintended pregnancies, sexually transmitted diseases, and disparities in these outcomes. The Centers for Disease Control and Prevention (CDC), Division of Reproductive Health, has a long history of working to improve access to and quality of ASRH services through applied research and public health practice. This report from CDC summarizes the evolution of these efforts from more than a decade of work-from community-based demonstration projects to an initiative to support wide-scale implementation. We describe a community-wide teen pregnancy prevention program model that includes a component addressing ASRH services (2010-2015), focused efforts related to quality improvement (QI) of and community-clinic linkages to ASRH services (2015-2020), and the development of a QI package that collates implementation strategies and tools to improve ASRH services (2020-2022). We conclude by discussing future directions. In disseminating key strategies and resources from this work, we aim to support broader public health and clinical efforts to strengthen ASRH care in the United States in ways that promote health equity.
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Affiliation(s)
- Anna W Brittain
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Riley J Steiner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy M Fasula
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kendra Hatfield-Timajchy
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aniket Kulkarni
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emilia H Koumans
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Doan THP, Adamson PC, Klausner JD. Legislation to Increase Accessibility to Direct-to-Consumer Tests in California. Sex Transm Dis 2022; 49:e37. [PMID: 34654766 PMCID: PMC8665099 DOI: 10.1097/olq.0000000000001570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Llata E, Cuffe KM, Picchetti V, Braxton JR, Torrone EA. Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018. MMWR. SURVEILLANCE SUMMARIES : MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES 2021; 70:1-20. [PMID: 34735419 PMCID: PMC8575410 DOI: 10.15585/mmwr.ss7007a1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM Sexually transmitted diseases (STDs) are a major cause of morbidity in the United States, with an estimated $15.9 billion in lifetime direct medical costs. Although the majority of STDs are diagnosed in the private sector, publicly funded STD clinics have an important role in providing comprehensive sexual health care services, including STD and HIV screening, for a broad range of patients. In certain cases, STD clinics often are the only source of sexual health care for patients, particularly among gay, bisexual, and other men who have sex with men (MSM). PERIOD COVERED 2010-2018. DESCRIPTION OF THE SYSTEM The STD Surveillance Network (SSuN) is an ongoing sentinel surveillance system for monitoring clinical information among patients attending STD clinics. SSuN is a collaboration of competitively selected state and city health departments that conduct facility-based sentinel surveillance in STD clinics. Information routinely collected through the course of patient encounters is obtained for all patients seeking care in the participating STD clinics. This information includes demographic, behavioral, and clinical characteristics (e.g., STD and HIV tests performed and STD and HIV diagnoses). This report presents 2010-2018 SSuN data from 14 STD clinics in five cities (Baltimore, Maryland; New York City, New York; Philadelphia, Pennsylvania; San Francisco, California; and Seattle, Washington) to describe the patient populations seeking care in these STD clinics. Estimated numbers and percentages of patients receiving selected STD-related health services were calculated for each year by using an inverse variance weighted random-effects model, adjusting for heterogeneity among SSuN jurisdictions. Trends in receipt of selected STD-related health services were examined and included HIV screening after an acute STD diagnosis among persons not previously known to have HIV infection, annual chlamydia screening among adolescent and young females, and extragenital chlamydia and gonorrhea screening among MSM. RESULTS During 2010-2018, the total number of annual visits made in the 14 participating STD clinics decreased 29.8% (from 145,728 to 102,275 visits), and the total number of unique patients examined in the clinics decreased 35.1% (from 94,281 to 61,172 patients). Decreases in the number of unique patients occurred both among men who have sex with women only (42.4%; from 37,842 in 2010 to 21,781 in 2018) and among females (51.4%; from 36,485 in 2010 to 17,721 in 2018). The decreases in the number of female patients were observed across all age groups, although they were more pronounced among females aged ≤24 years (66.4%; from 17,721 in 2010 to 5,962 in 2018). In contrast, the number of patients identified as MSM increased 44.0% (from 12,859 in 2010 to 18,512 in 2018), with the greatest increase among MSM aged ≥25 years (58.6%; from 9,918 in 2010 to 15,733 in 2018). Among visits during which an acute STD (defined as chlamydia, gonorrhea, or primary or secondary syphilis) was diagnosed, the percentage of visits during which an HIV test was performed within approximately 14 days of the STD diagnosis increased from 58.2% in 2010 to 70.2% in 2018. Among those patients tested, 1,672 HIV infections were identified, of which 84.0% were among MSM. Among females aged 15-24 years, the percentage screened for chlamydia in any calendar year increased from 88.6% in 2010 to 90.6% in 2018. However, because fewer females aged 15-24 years attended these clinics during the study period, the crude number of adolescent and young females tested for chlamydia decreased from 14,249 in 2010 to 4,507 in 2018. During 2010-2018, the percentage of females retested after their first positive chlamydia diagnosis during the same year ranged from 11.4% to 13.3%. During 2010-2018, the percentage of MSM tested for rectal chlamydia and rectal gonorrhea increased (from 54.7% to 57.8% and from 55.0% to 58.4%, respectively). During the same period, increases were noted in the percentage of MSM with diagnosed rectal chlamydia (from 15.5% in 2010 to 17.7% in 2018) and rectal gonorrhea (from 13.3% in 2010 to 17.1% in 2018). In contrast with pharyngeal chlamydia, pharyngeal gonorrhea screening was more common (from 69.5% in 2010 to 74.6% in 2018), and the percentage positive doubled during the study period (from 7.3% in 2010 to 14.8% in 2018). Pharyngeal chlamydia testing also increased (from 50.3% in 2010 to 72.9% in 2018), with concurrent decreases in positivity (from 4.2% in 2010 to 2.6% in 2018). INTERPRETATION During 2010-2018, changes occurred in the demographic composition of patients attending STD clinics participating in SSuN. Understanding trends in the demographic profile of STD patients and services provided can help identify addressable gaps in STD control efforts and direct public health action. Overall, fewer females, especially those aged 15-24 years, accessed care in these STD clinics during the study period. Untreated STDs among adolescent and young females can have serious consequences, including pelvic inflammatory disease and infertility. Additional efforts to monitor where adolescent and young females seek care and to ensure they are receiving quality STD-related health services are needed, especially considering increases in reported cases of STDs among females. Increases in the number of MSM attending STD clinics present a unique opportunity to reach this population with STD and HIV prevention services. Although a large percentage of STD cases are diagnosed outside of STD clinics, publicly funded STD clinics are an important safety-net provider of STD-related health services and provide vital STD-related health services for patient populations at risk for the consequences of STDs and HIV infection. PUBLIC HEALTH ACTIONS STD-related health services represent effective strategies for preventing STD and HIV transmission and acquisition or STD-related sequelae. Ensuring that all persons receive quality HIV and STD prevention and treatment services is vital for an effective public health approach to reducing STDs. STD clinics provide crucial safety-net services for preventing STD-related morbidity, including timely identification and treatment of curable STDs such as chlamydia, gonorrhea, and syphilis. Increases in the numbers of MSM attending STD clinics participating in SSuN provide additional opportunities for linking patients to high-impact HIV preventive services (e.g., pre-exposure prophylaxis), and the clinics are positioned to facilitate initiation or resumption of treatment among persons living with HIV.
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Affiliation(s)
- Eloisa Llata
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Kendra M Cuffe
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Viani Picchetti
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Jimmy R Braxton
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Elizabeth A Torrone
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
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Gogineni V, Waselewski ME, Jamison CD, Bell JA, Hadler N, Chaudhry KA, Chang T, Mmeje OO. The future of STI screening and treatment for youth: a National Survey of youth perspectives and intentions. BMC Public Health 2021; 21:2006. [PMID: 34736427 PMCID: PMC8567981 DOI: 10.1186/s12889-021-12091-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/18/2021] [Indexed: 12/30/2022] Open
Abstract
Background Sexually transmitted infection (STI) rates continue to rise in the U.S., with disproportionately high rates among those aged 15–24 years. Effective programs and policies are necessary to address this growing public health problem. The purpose of this study is to assess the perspectives of a national sample of youth on access to STI care and behaviors regarding STIs. Methods MyVoice, a national text message survey of youth, was used to pose four open-ended questions on STI screening and treatment to 1115 youth aged 14–24 in August 2018. A mixed-methods strategy was employed for the study. Qualitative data was analyzed using a modified grounded theory approach. Summary statistics were calculated for demographic data and prevalence of themes. Results Of the 800 participants who responded to at least one question (72% response rate), mean age was 19 years (SD = 3.1), 55% identified as female, 61% identified as non-Hispanic white, and 33% qualified for free/reduced lunch. A majority felt it would be easy to get screened (69%) or treated (68%) for an STI. Nearly all respondents (95%) stated they would share an STI diagnosis with their sexual partners. Conclusions Despite high rates of STIs among youth, most respondents reported that STI screening and treatment is accessible, and they would share an STI diagnosis with their partner. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12091-y.
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Affiliation(s)
- Vinaya Gogineni
- The University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH, 43614, USA
| | - Marika E Waselewski
- University of Michigan Department of Family Medicine, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Cornelius D Jamison
- University of Michigan Department of Family Medicine, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA.,University of Michigan Institute for Healthcare Policy and Innovation, 2800 Plymouth Rd. Bldg. 16, Ann Arbor, MI, 48109, USA
| | - Jasmine A Bell
- University of Michigan Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr., L4100 Women's Hospital, Ann Arbor, MI, 48109, USA
| | - Nicole Hadler
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA
| | - Kiren A Chaudhry
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Tammy Chang
- University of Michigan Department of Family Medicine, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA.,University of Michigan Institute for Healthcare Policy and Innovation, 2800 Plymouth Rd. Bldg. 16, Ann Arbor, MI, 48109, USA.,National Clinician Scholars Program, University of Michigan, 2800 Plymouth Rd. Bldg. 16, Ann Arbor, MI, 48109, USA
| | - Okeoma O Mmeje
- University of Michigan Institute for Healthcare Policy and Innovation, 2800 Plymouth Rd. Bldg. 16, Ann Arbor, MI, 48109, USA. .,University of Michigan Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr., L4100 Women's Hospital, Ann Arbor, MI, 48109, USA. .,Department of Health Behavior and Health Education, University of Michigan School of Public Health, 415 Washington Heights, Ann Arbor, MI, 48109, USA.
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Diagnostic tests for detecting Chlamydia trachomatis and Neisseria gonorrhoeae in rectal and pharyngeal specimens. J Clin Microbiol 2021; 60:e0021121. [PMID: 34731021 DOI: 10.1128/jcm.00211-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Chlamydia trachomatis and Neisseria gonorrhoeae are two of the most often reported bacterial infections in the United States. The rectum and oropharynx are important anatomic sites of infection and can contribute to ongoing transmission. Nucleic acid amplification tests (NAATs) are the mainstays for the detection of C. trachomatis and N. gonorrhoeae infections owing to their high sensitivity and specificity. Several NAATs have been evaluated for testing in rectal and pharyngeal infections. A few assays recently received clearance by the Food and Drug Administration, including one point-of-care test. Those assays can be used for testing in symptomatic individuals, as well as for asymptomatic screening in certain patient populations. Routine screening for C. trachomatis in pharyngeal specimens is not recommended by the Centers for Disease Control and Prevention, though is often performed due to the use of multiplex assays. While expanding the types of settings for screening and using self-collected rectal and pharyngeal specimens can help to increase access and uptake of testing, additional research is needed to determine the potential benefits and costs associated with increased screening for rectal and pharyngeal C. trachomatis and N. gonorrhoeae infections on a population level.
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Exten C, Pinto CN, Gaynor AM, Meyerson B, Griner SB, Van Der Pol B. Direct-to-Consumer Sexually Transmitted Infection Testing Services: A Position Statement from the American Sexually Transmitted Diseases Association. Sex Transm Dis 2021; 48:e155-e159. [PMID: 34030157 PMCID: PMC8505153 DOI: 10.1097/olq.0000000000001475] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Direct-to-consumer test services have gained popularity for sexually transmitted infections in recent years, with substantially increased use as a result of the SARS-CoV-2 (CoVID-19) global pandemic. This method of access has been variously known as "self-testing," "home testing," and "direct access testing." Although these online services may be offered through different mechanisms, here we focus on those that are consumer-driven and require self-collected samples, and sample shipment to a centralized laboratory without involvement of health care providers and/or local health departments. We provide the American Sexually Transmitted Diseases Association's position on utilization of these services and recommendations for both consumers and health care providers.
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Affiliation(s)
- Cara Exten
- From the The Pennsylvania State University College of Nursing, University Park
| | - Casey N. Pinto
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA
| | - Anne M. Gaynor
- Association of Public Health Laboratories, Silver Spring, MD
| | - Beth Meyerson
- College of Social and Behavioral Sciences, Southwest Institute for Research on Women, University of Arizona, Tucson, AZ
| | - Stacey B. Griner
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX
| | - Barbara Van Der Pol
- Schools of Medicine
- Public Health, University of Alabama at Birmingham, Birmingham, AL
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Lederer AM, Hindmarch G, Schmidt N, Gomes GR, Scott G, Watson S, Kissinger PJ. Facilitators and Barriers to Patient-Delivered Partner Therapy Acceptance for Chlamydia trachomatis Among Young African American Men Who Have Sex With Women in a Southern Urban Epicenter. Sex Transm Dis 2021; 48:823-827. [PMID: 33993165 PMCID: PMC9708115 DOI: 10.1097/olq.0000000000001470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chlamydia trachomatis (Ct) disproportionately affects African American young people living in the Southern United States and can have negative consequences if left untreated. Patient-delivered partner therapy (PDPT) is an evidence-based practice in which individuals diagnosed with Ct can provide treatment directly to their sex partners. However, PDPT acceptance rates need improvement. Although reasons for PDPT acceptance have been explored previously, the facilitators and barriers to expedited partner therapy acceptance among young southern African American men who have sex with women have not yet been examined. METHODS Twenty semistructured interviews were conducted as part of a community-based Ct screening and treatment intervention among African American men aged 15 to 25 years who had female sex partners. Participants were asked about why they did or did not accept PDPT for their sex partners. Data were transcribed and analyzed in NVivo qualitative software using an inductive thematic approach. RESULTS Participants' decision making was multifaceted. Facilitators for PDPT acceptance included being able to cure their partner, convenient access to treatment, believing it was the right thing to do, having a close relationship with a partner, concern for the partner's well-being, and the perceived severity of Ct. Barriers to PDPT acceptance were the belief that a partner did not need treatment, not having a close relationship with the partner, being unable to contact the partner, and fear of conflict. CONCLUSIONS Findings had similarities to other studies, indicating some universal messaging may be warranted alongside culturally tailored interventions for specific patient populations to increase PDPT acceptance. Implications for patient-provider communication are provided.
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Affiliation(s)
- Alyssa M. Lederer
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Grace Hindmarch
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Norine Schmidt
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Gérard R. Gomes
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Glenis Scott
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Shannon Watson
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Patricia J. Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Maheux AJ, Zhou Y, Thoma BC, Salk RH, Choukas-Bradley S. Examining Sexual Behavior Among U.S. Transgender Adolescents. JOURNAL OF SEX RESEARCH 2021; 58:1050-1060. [PMID: 33356600 PMCID: PMC8236068 DOI: 10.1080/00224499.2020.1855408] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The health of transgender adolescents (i.e., those identifying with a gender other than their sex assigned at birth) is gaining attention from researchers, yet little work has examined normative sexual behaviors among this population. Self-identified gender minority adolescents, including those identifying as trans boys, trans girls, nonbinary, and questioning their gender identity (age range 14-18, Mage = 16, n = 1,223) from all 50 U.S. states responded to anonymous online surveys. Participants reported on their age of initiation and number of sexual partners for four sexual behaviors ranging in intimacy (i.e., sexual touching, oral sex, vaginal sex, and anal sex). Participants also indicated the gender of their sexual partners and experiences with sexually transmitted infections (STIs), STI tests, and pregnancy. Overall, transgender adolescents' age of initiating sexual behaviors and number of sexual partners are similar to those observed in prior studies of cisgender adolescents. No differences were found between gender identity subgroups on ever engaging, age of initiation, number of partners, and gender of partners across the four sexual behaviors, with some exceptions for anal sex. Participants reported low rates of STIs and pregnancy, but also low rates of STI testing. Implications for sex education and health care are discussed.
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Affiliation(s)
- Anne J. Maheux
- University of Pittsburgh, Department of Psychology
- University of Delaware, Department of Psychological and Brain Sciences
| | - Yiyao Zhou
- University of Pittsburgh, Department of Psychology
- Indiana University Bloomington, Department of Counseling and Educational Psychology
| | | | | | - Sophia Choukas-Bradley
- University of Pittsburgh, Department of Psychology
- University of Delaware, Department of Psychological and Brain Sciences
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50
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Ong JJ, Fairley CK, Hocking JS, Turner KME, Booton R, Tse D, Wong WWCW. Preferences for chlamydia testing and management in Hong Kong: a discrete choice experiment. Sex Transm Infect 2021; 98:408-413. [PMID: 34535577 DOI: 10.1136/sextrans-2021-055182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/05/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES As most chlamydia cases are asymptomatic, regular testing and timely management may be necessary for control. We aimed to determine the preferences of people living in Hong Kong for chlamydia testing and management services. METHODS An online panel of sexually active individuals living in Hong Kong completed the survey with two discrete choice experiments (DCEs). The first DCE examined the preferred attributes of a chlamydia testing service (cost, location, appointment time, speed of results, delivery of results and availability of other STI testing). The second DCE examined the preferred attributes of a chlamydia management service (cost, access to patient-delivered partner therapy, location, travel time, type of person consulted and attitude of staff). RESULTS In total, 520 individuals participated: average age 36.8 years (SD 9.9), 40% males and 66% had a bachelor's degree or higher. Choosing to test was most influenced by cost, followed by speed of results, delivery of results, extra STI testing, appointment available and the least important was the location of testing. Choosing to attend for management was most influenced by staff's attitude, followed by cost, who they consult, access to patient-delivered partner therapy, travel time and the least important was treatment location. CONCLUSION To design effective chlamydia testing and management services, it is vital to respond to patient needs and preferences. For people living in Hong Kong, cost and staff attitude were the most important factors for deciding whether to test or be managed for chlamydia, respectively.
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Affiliation(s)
- Jason J Ong
- Central Cllinical School, Monash University, Melbourne, Victoria, Australia .,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Cllinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Katy M E Turner
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Ross Booton
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Desiree Tse
- Department of Family Medicine & Primary Care, University of Hong Kong, Hong Kong, Hong Kong
| | - William W C W Wong
- Department of Family Medicine & Primary Care, University of Hong Kong, Hong Kong, Hong Kong.,Department of Family Medicine & Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People's Republic of China
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