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Hoffman ND, Ciarleglio A, Lesperance-Banks S, Corbeil T, Kaur H, Silver EJ, Bauman L, Sandfort TGM. A Provider-Focused Intervention to Increase Universal HIV Testing among Adolescents in School-Based Health Centers. AIDS Behav 2024:10.1007/s10461-024-04444-6. [PMID: 39046611 DOI: 10.1007/s10461-024-04444-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/25/2024]
Abstract
We describe a provider-focused intervention to increase universal HIV testing among adolescent users in a network of School-Based Health Centers (SBHC) and compare the rate of HIV test offer and acceptance for SBHCs with and without the HIV testing intervention. The intervention was implemented at the six largest SBHCs in the 12-site network and included system- and staff-level initiatives, including an implementation coach to support SBHC associates. Rates of HIV test offer and acceptance at six sites in the Intervention Cohort were compared to that at the six sites in a Non-Intervention Cohort which was not randomly selected but had comparable distributions by age, gender and race/ethnicity. The model showed an intervention effect for universal HIV test offer, but no overall effect for test acceptance. Analyzing the intervention effect by whether a patient had a history of sexual activity, the intervention was very effective early in its implementation at increasing test offer to those with no history of sexual activity, and late in its implementation at increasing test acceptance for those with no or unknown sexual activity. Increasing and sustaining universal HIV testing in SBHCs may benefit from using Implementation Science frameworks to guide adaptation of the intervention.
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Affiliation(s)
- Neal D Hoffman
- Division of Adolescent Medicine, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY, 10467, USA.
| | - Adam Ciarleglio
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | | | - Tom Corbeil
- New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
| | - Harpreet Kaur
- Preventive Intervention Research Center for Child Health, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ellen J Silver
- Preventive Intervention Research Center for Child Health, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Laurie Bauman
- Preventive Intervention Research Center for Child Health, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Theo G M Sandfort
- New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
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Belcher K, Fishman E, Ramirez-Mercado K, Marshall B, DiPaolo M, Jarpe-Ratner E. Facilitators and Barriers to Implementing a Comprehensive Sexual Health Education Policy in Chicago Public Schools. THE JOURNAL OF SCHOOL HEALTH 2024. [PMID: 38965747 DOI: 10.1111/josh.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND In 2013, the Chicago Public Schools (CPS) district passed a policy requiring schools to deliver comprehensive sexual health education (SHE) to all K-12th grade students. A performance improvement case study was conducted in the 2019-2020 school year to evaluate the implementation of the policy and identify lessons learned to support implementation in schools. METHODS Key informant interviews were conducted with 11 school principals and 29 teachers to discuss SHE implementation at their school. Interviews were recorded, transcribed, and analyzed to assess school and classroom factors that affect implementation. Themes that cut across these factors were then identified and summarized by 2 evaluators. RESULTS The following themes were identified across key informant interviews: (a) principal prioritization of SHE helps ensure SHE is implemented, (b) the expansion of school and teacher capacity facilitates SHE implementation, and (c) the creation of accountability mechanisms in classrooms and schools fosters adherence to SHE policy. CONCLUSIONS Principals play a crucial role in building capacity to deliver SHE and ensuring SHE accountability mechanisms are implemented in their school. CPS is using these findings to adjust technical assistance and resources provided to principals and SHE instructors.
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Affiliation(s)
- Kristen Belcher
- University of Illinois, Chicago School of Public Health, Chicago, IL
| | | | - Kat Ramirez-Mercado
- Health Promotion, Office of Student Health and Wellness, Chicago Public Schools, Chicago, IL
| | - Booker Marshall
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Marisa DiPaolo
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Suarez NA, McKinnon II, Krause KH, Rasberry CN, Pampati S, Michael Underwood J. Disparities in behaviors and experiences among transgender and cisgender high school students - 18 U.S. states, 2021. Ann Epidemiol 2024; 94:113-119. [PMID: 38734191 PMCID: PMC11134401 DOI: 10.1016/j.annepidem.2024.05.004] [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: 02/01/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE Transgender youth (those whose gender identity differs from their sex assigned at birth) experience stigma and discrimination that can place them at increased risk for poor health outcomes compared with cisgender youth (those whose gender identity aligns with their sex assigned at birth). Limited population-based data exist on disparities among transgender and cisgender youth. METHODS We examined differences in experiences of violence, substance use, mental health, suicide, sexual behavior, unstable housing, parental monitoring, and school connectedness among 98,174 transgender and cisgender high school students using data from 18 states that included an item to assess transgender identity on their 2021 Youth Risk Behavior Survey. RESULTS Overall, 2.9% of students identified as transgender and 2.6% questioned whether they were transgender. Among transgender students, 71.5% reported that their mental health was not good, 32.3% had attempted suicide, and 29.0% experienced sexual violence. Transgender students were more likely than cisgender students to report experiences of violence, substance use, poor mental health, suicide risk, some sexual risk behaviors, and unstable housing, and were less likely to report feeling connected to others at school. CONCLUSIONS Interventions that can address the causes of these adverse outcomes and promote the health and wellbeing of transgender youths are warranted.
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Affiliation(s)
- Nicolas A Suarez
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4770 Buford Hwy NE, Atlanta, GA 30341, USA.
| | - Izraelle I McKinnon
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Kathleen H Krause
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Catherine N Rasberry
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Sanjana Pampati
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - J Michael Underwood
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC 4770 Buford Hwy NE, Atlanta, GA 30341, USA
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Moolla A, Constance M, Ngcobo N, Mngadi S, Govathson C, Long L, Pascoe SJ. "I want one nurse who is friendly to talk to me properly like a friend": Learner preferences for HIV and contraceptive service provision in Gauteng, South Africa. RESEARCH SQUARE 2023:rs.3.rs-3725260. [PMID: 38168214 PMCID: PMC10760307 DOI: 10.21203/rs.3.rs-3725260/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Research with adolescents indicates that youth aged 15-24 years, especially females, are at high risk for HIV infection. The overall HIV prevalence among youth in this age group was 6.2% estimated in 2022. In addition, > 800,000 adolescents are newly infected with HIV every year and 79% of these infections occur in sub-Saharan Africa. The health service provision preferences and needs of adolescents are critical to reaching this population. Methods This qualitative study was conducted with learners from three public secondary schools in Gauteng, South Africa. Using convenience sampling, 22 in-depth stakeholder interviews (KIIs) with stakeholders and 8 focus group discussions (FGDs) with 55 learners aged ≥ 15, were conducted between March and October 2018. Learners < 18 were given assent and parental consent forms, whilst those ≥ 18 could consent of their own accord. KIIs and FGDs were conducted in private venues in the preferred language by trained interviewers and audio-recorded. Audio files were transcribed verbatim and translated into English if needed. Data were analysed thematically using NVivo version 11. Results The findings from both stakeholders and learners indicate many critical accessibility barriers which include: negative healthcare staff attitudes from older judgemental staff; stigmatisation from healthcare workers, the community as well as family; a lack of private consulting spaces and no confidentiality of patient information at facilities; inconvenient clinic operating times; long queues and facility resource issues. Both groups of participants suggested that accessibility to healthcare could be improved through value-added services (including free Wi-Fi and food), social gatherings and educational information sessions, as well as being staffed by younger, friendlier, confidential and non-judgemental staff in a private healthcare setting. Conclusion It is clear that there are many critical barriers that deter learners from accessing HIV and contraceptive services. Provision of private rooms and trying to ensure information confidentiality for youth-friendly services at locations and times that can be easily accessed by learners is key. Greater emphasis on learner-parent-teacher communication around sexual health education at school is needed along with making this information being more readily available to learners.
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Ramteke RU, Makade JG, Bandre GR. Adolescent Sexual Behavior in Rural Central India: Challenges and Interventions. Cureus 2023; 15:e49761. [PMID: 38164411 PMCID: PMC10758265 DOI: 10.7759/cureus.49761] [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: 10/04/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Adolescence is a crucial life stage marked by significant physical, psychological, and societal changes. With India projected to have the highest population of teenagers by 2025, understanding adolescent sexual behavior in rural central India is essential due to its unique social and cultural contexts. This article reviews existing literature to explore the prevalence, risk factors, and consequences of teenage sexual behavior in rural central India. It highlights the challenges posed by societal taboos, limited access to sexual health information and services, and the impact of poverty on adolescents' sexual behavior and health outcomes. To address these issues, comprehensive sex education, improved access to contraception and reproductive health services, and efforts to overcome cultural and societal norms are crucial. The article discusses the initiatives undertaken by the government and non-governmental organizations (NGOs) to tackle adolescent sexual behavior and emphasizes the need for a multifaceted approach that addresses systemic issues while empowering adolescents. It concludes by suggesting future research directions and policy recommendations aimed at promoting safe sexual behavior among rural adolescents in central India. This article will discuss the complexity of adolescent sexual behavior in rural central India, its origins, and the challenges faced by medical decision-makers.
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Affiliation(s)
- Rahul U Ramteke
- Forensic Medicine, Shri Shankaracharya Institute of Medical Sciences, Bhilai, IND
| | - Jagadish G Makade
- Community Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
| | - Gulshan R Bandre
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, IND
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Factors Associated with Commercial Sex Behavior among Male College Students Who Engaged in Temporary Heterosexual Behavior in Zhejiang Province, China. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4319194. [PMID: 36619304 PMCID: PMC9822748 DOI: 10.1155/2022/4319194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/01/2023]
Abstract
Objective This study explored the characteristics and associated factors of commercial sex behavior among male college students who engaged in temporary heterosexual behaviors in Zhejiang Province, China. Methods The participants were male college students with temporary heterosexual behaviors. We developed an online questionnaire to collect information on demographic characteristics, sexual attitudes, sexual behaviors, and HIV/AIDS interventions through stratified cluster sampling. Chi-square (χ 2) tests were performed for the different groups of participants. The occurrence of commercial sex behavior among participants was taken as the dependent variable, and logistic regression was used to analyze the factors associated with the participants' commercial sex behavior. Results This study investigated the temporary heterosexual behavior of 424 male college students. Among them were 112 students who reported commercial sex behavior (26.42%), whose average age was 20.25 ± 1.27 years, and whose household registration of Zhejiang Province accounted for 63.39%. The results of the multivariate logistic regression analysis indicated that acceptance of commercial sex behavior (Adjusted (a) OR = 3.53, 95% CI = 1.94~6.40) and feeling at risk of contracting HIV (aOR = 6.44, 95% CI = 2.98~13.94), seeking temporary sexual partners through the Internet (aOR = 2.58, 95% CI = 1.27~5.25), consistently using condoms during sex (aOR = 0.34, 95% CI = 0.16~0.70), or using condoms sometimes/frequently during sex (aOR = 0.30, 95% CI = 0.13~0.68) were independent factors associated with male college students with temporary heterosexual behavior engaging in commercial sex behavior. Conclusion Open sexual attitudes, seeking temporary sexual partners through the Internet, high awareness of HIV infection risk, and low condom use are associated factors for male college students engaging in commercial sex behavior. For college students' HIV/AIDS prevention and education interventions, it is necessary to strengthen the prevention of network influence, increase peer education, increase teacher participation in education, enhance college students' risk awareness, advocate for the use of condoms, and promote HIV/AIDS prevention and treatment.
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Young E, Demissie Z, Brener ND, Benes S, Szucs LE. Trends in Teaching Sexual and Reproductive Health Skills in US Secondary Schools in 35 States, 2008 to 2018. THE JOURNAL OF SCHOOL HEALTH 2022; 92:711-719. [PMID: 35322428 PMCID: PMC9307078 DOI: 10.1111/josh.13179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Little is known about trends in implementing skills-based instruction in US schools, specifically for sexual and reproductive health (SRH). We examined state-level trends in the percentage of US secondary schools teaching SRH skills in a required course in grades 6 to 8 and 9 to 12. METHODS Representative data from 35 states participating across 6 cycles of School Health Profiles (2008-2018) was analyzed. The prevalence of teaching four SRH skills was assessed through lead health education teacher self-administered questionnaires. Logistic regression models examined linear trends in the percentages of schools teaching SRH skills in grades 6 to 8 and 9 to 12. Trends were calculated for states with weighted data (response rates ≥70%) for at least 3 cycles, including 2018. RESULTS During 2008 to 2018, the median percentage of schools addressing each SRH skill ranged from 63.5% to 69.7% (grades 6-8) and 88.2% to 92.0% (grades 9-12). Linear decreases in SRH skills instruction were more common for grades 6 to 8 than grades 9 to 12; linear increases were comparable for both groups. Most states demonstrated no change in the percentage of schools teaching SRH skills in grades 6 to 8 and 9 to 12. CONCLUSIONS Limited changes and decreases in SRH skills instruction in US secondary schools suggest efforts to strengthen SRH education are needed.
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Affiliation(s)
- Emily Young
- Oak Ridge Associated Universities, 1299 Bethel Valley Road, Oak Ridge, TN 37830; The Centers for Disease Control and Prevention, Division of Adolescent and School Health 1600 Clifton Road, NE, US8-1, Atlanta, GA 30329-4027
| | - Zewditu Demissie
- The Centers for Disease Control and Prevention, Division of Adolescent and School Health 1600 Clifton Road, NE, US8-1, Atlanta, GA 30329-4027; U.S. Public Health Service Commissioned Corps 1101 Wootton Pkwy, Rockville, MD 20852
| | - Nancy D. Brener
- The Centers for Disease Control and Prevention, Division of Adolescent and School Health 1600 Clifton Road, NE, US8-1, Atlanta, GA 30329-4027
| | - Sarah Benes
- Merrimack College 315 Turnpike Street, North Andover, MA 01845
| | - Leigh E. Szucs
- The Centers for Disease Control and Prevention, Division of Adolescent and School Health 1600 Clifton Road, NE, US8-1, Atlanta, GA 30329-4027
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Brindis CD. Advancing Sexual and Reproductive Health Education-Pursuing the Long Arc of Justice. J Adolesc Health 2022; 70:521-522. [PMID: 35305788 DOI: 10.1016/j.jadohealth.2022.01.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
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