Accessing sexual health information online: use, motivations and consequences for youth with different sexual orientations

Understanding the contents and gaps in sexual and reproductive health toolkits designed for adolescence and young adults: a scoping review

INTRODUCTION

Adolescence is a crucial stage of physical and sexual maturation and development and a period in which understanding sexual and reproductive health (SRH) is important. SRH interventions and toolkits provide a range of valuable resources and information to young people, educators, and members of the community on numerous topics, including contraception and puberty.

OBJECTIVES

The usefulness and reliability of these available toolkits have not been previously studied, thus limiting our understanding of their appropriateness and contents. Hence, this scoping review aimed to synthesize the available toolkits aimed at the SRH of adolescents and young adults to understand the contents, design, and information gaps.

METHODS

A systematic search was conducted of 6 medical databases and 12 gray literature sites. Sixteen toolkits published globally before May 2023 were included in our review.

RESULTS

The majority of toolkits (n = 12) contained information related to general SRH knowledge and contraception, whereas only 3 contained information on teenage pregnancy. We found that aiming the toolkits toward educators and health care workers was a favorable design over targeting adolescents and young adults directly and that vulnerable youth-including LGBTQI+ (lesbian, gay, bisexual, transgender, queer or questioning, asexual or allied, intersex, and additional identities) and youth from humanitarian settings-were not well represented.

CONCLUSION

We identified key gaps in the inclusion of information in a range of SRH topics, such as LGBTQI+ sexuality, teenage pregnancy, and safe abortion, in the currently available SRH toolkits and their lack of applicability in a global context. Furthermore, we provide recommendations for areas of improvement to encourage adolescents' agency in their SRH education.

In the Know: A Cluster Randomized Trial of an In-person Sexual Health Education Program Integrating Digital Technologies for Adolescents

PURPOSE

Integrating digital technologies into sexual health education can offer advantages for connecting with adolescents, particularly populations who may be underserved through common school-based approaches. This study assessed the effectiveness of In the Know, an in-person, group-based sexual health education program integrating digital technologies, codesigned with adolescents.

METHODS

The study design was a cluster randomized trial with 1,263 adolescents aged 13-19 in 95 cohorts, implemented in community-based organizations and schools throughout Fresno County, California. Participants completed a baseline survey and a follow-up survey 3 months later. Two-level mixed-effects regression models with random intercepts for cohort were used to estimate the intervention's impact on unprotected sex, use of clinical health services, knowledge of local sexual health services, technology use to find or schedule services, and sexual health knowledge at the 3-month follow-up.

RESULTS

The average age of participants was 15.7 years, and the majority identified as Hispanic (71%). In adjusted analyses, intervention group participants were more likely to use clinical services (42.7% vs. 33.2%, p = .009) and reported greater sexual health knowledge at 3 months (57.6% of items answered correctly vs. 50.7%, p = .001). No significant differences were observed in the other outcomes by study group.

DISCUSSION

In the Know participants demonstrated greater use of clinical health services and sexual health knowledge at 3 months. The study findings show the potential for incorporating user-centered design and technology into sexual health education to better support adolescents who may have limited access to this important information.

Using an intersectional life course perspective to understand familial environment and its impact on sexuality development among Asian American sexual minority college students

There is a dearth of research understanding the sexual health of Asian American adolescents, and even more so for those who identify as sexual minorities (lesbian, gay, bisexual, queer, asexual, and other sexual orientations). This study is a secondary qualitative analysis focused on young adults' recollections of their formal and informal sex education experiences in childhood and adolescence using a sub-sample of in-depth interviews from students who self-identified as both Asian and sexual minorities living in the USA (n = 9). Results were organised into three sections: (1) latent cultural factors (e.g. stigma surrounding sex, self-sufficiency, filial piety); (2) the downstream effects of latent cultural factors (e.g. sex-related discussions, rules disallowing dating, role of lateral family members); and (3) the impact of deficient familial sex-related discussions (e.g. Internet, resentment). Study findings underscore the links between identity concealment and relationship concealment that are unique to Asian sexual minority individuals. We suggest that interventions involving Asian American US youth and their families should be culturally informed and promote cross-generational sex-related discussion. Future research should further explore the role of chosen family and non-parental family members as a point of intervention as they can be helpful sources of informal sex education.

[Consequences of digital media on the health of children and adolescents with a focus on the consumption of unhealthy foods]

Children and adolescents' media time has increased since 2019. Prolonged time spent with media and media multitasking is increasingly being discussed as a health determinant. This narrative review highlights the importance of media time on the development of obesity and metabolic disorders in children and adolescents and discusses in more detail the associations with consumption of unhealthy foods and increased exposure to media food marketing.The prolonged durations that children and adolescents spend with social and digital media in their leisure time are positively related to sensory taste preferences for sweet, fatty, and salty foods as well as to higher snack food and energy intakes. Moreover, prolonged media time is also associated with a long-term increased risk of metabolic syndrome and its single components. The potential of social media for promoting physical activity and healthy eating lies especially in simplifying the inclusion of otherwise hard-to-reach groups. Further, social media may facilitate social support from peers and thus positively influence the well-being of young users.Particularly against the background of the not yet fully developed cognitive abilities of children and adolescents, the article refers to options for action to protect young media users. Exposure to certain social media content appears to negatively relate to children and adolescents' food choices and eating behaviors, supporting the call to regulate advertising directed at young consumers for foods and beverages that do not meet WHO criteria for child-friendly foods in these media.

Social media and online safety practices of young parents

Studies of parents' online safety concerns typically centre on information privacy and on worries over unknown third parties preying on children, whereas investigations into youth perspectives on online safety have found young people to focus on threats to safety or reputation by known individuals. The case of youth who are themselves parents raises questions regarding how these differing perspectives are negotiated by individuals who are in dual roles as youth and parents. Using interview and ethnographic observation data from the longitudinal Young Parent Study in British Columbia, Canada, this analysis investigates social media and online safety practices of 113 young parents. Online safety concerns of young parents in this study focused on personal safety, their children's online privacy and image management. These concerns reflect their dual roles, integrating youth image and information management concerns with parental concerns over the safety and information privacy of their own children.

Community-Engaged Participatory Methods to Address Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Young People's Health Information Needs With a Resource Website: Participatory Design and Development Study

BACKGROUND

Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) young people (aged 15 to 25 years) face unique health challenges and often lack resources to adequately address their health information needs related to gender and sexuality. Beyond information access issues, LGBTQ+ young people may need information resources to be designed and organized differently compared with their cisgender and heterosexual peers and, because of identity exploration, may have different information needs related to gender and sexuality than older people.

OBJECTIVE

The objective of our study was to work with a community partner to develop an inclusive and comprehensive new website to address LGBTQ+ young people's health information needs. To design this resource website using a community-engaged approach, our objective required working with and incorporating content and design recommendations from young LGBTQ+ participants.

METHODS

We conducted interviews (n=17) and participatory design sessions (n=11; total individual participants: n=25) with LGBTQ+ young people to understand their health information needs and elicit design recommendations for the new website. We involved our community partner in all aspects of the research and design process.

RESULTS

We present participants' desired resources, health topics, and technical website features that can facilitate information seeking for LGBTQ+ young people exploring their sexuality and gender and looking for health resources. We describe how filters can allow people to find information related to intersecting marginalized identities and how dark mode can be a privacy measure to avoid unwanted identity disclosure. We reflect on our design process and situate the website development in previous critical reflections on participatory research with marginalized communities. We suggest recommendations for future LGBTQ+ health websites based on our research and design experiences and final website design, which can enable LGBTQ+ young people to access information, find the right information, and navigate identity disclosure concerns. These design recommendations include filters, a reduced number of links, conscientious choice of graphics, dark mode, and resources tailored to intersecting identities.

CONCLUSIONS

Meaningful collaboration with community partners throughout the design process is vital for developing technological resources that meet community needs. We argue for community partner leadership rather than just involvement in community-based research endeavors at the intersection of human-computer interaction and health.

Sources of Information about Pre-Exposure Prophylaxis (PrEP) and Associations with PrEP Stigma, Intentions, Provider Discussions, and Use in the United States

The amount and type of information individuals receive about HIV pre-exposure prophylaxis (PrEP) may influence PrEP uptake. We surveyed 331 HIV-negative sexual and gender minorities who have sex with men at a Midwestern Pride festival in 2018 (Mage = 32, 68% White, 87% cisgender men) to assess sources and perceived tone of PrEP information and associated outcomes. Most participants (88%) had heard about PrEP. The most common sources were the internet (70%), social media (59%), and friends (54%). Messages from health campaigns were perceived as most positive and those from religious institutions as least positive. Sources differed based on demographics. Controlling for indications for PrEP use, those who heard about PrEP from health campaigns and those who heard more positive messages reported lower levels of PrEP stigma, βs = -0.27--0.23, ps < .05. Non-users who heard about PrEP from the internet had stronger intentions to use PrEP, β = 0.28, p < .05. Those who heard about PrEP from sexual partners and health campaigns were more likely to discuss PrEP with providers, PRs = 1.60-1.80, ps < .01. Finally, those who heard about PrEP from friends and partners were more likely to use PrEP, PRs = 2.01-2.24, ps < .05. Leveraging sexual partners, social network members, and health campaigns are promising avenues to advance PrEP implementation.

Effectiveness of the SMART Sex Ed program among 13-18 year old English and Spanish speaking adolescent men who have sex with men

Adolescent men who have sex with men (AMSM) have a high HIV incidence and low utilization of testing and prevention services. However, very few HIV prevention programs exist that focus on the unique sexual health needs of AMSM. SMART is a stepped care package of eHealth interventions that comprehensively address the sexual and HIV prevention needs of AMSM. This study examines the impact of the first step of SMART, "SMART Sex Ed," on 13- to 18-year-old AMSM (n = 983) from baseline to three-month follow-up across 18 separate outcomes measuring HIV prevention attitudes, skills, and behaviors. We observed significant change from baseline to three-month post-intervention in nine HIV-related outcomes (e.g., receipt of HIV and STI test, HIV knowledge), as well as largely consistent effects across demographic subgroups (e.g., race, age, rural, low SES). Analyses observed no effects on condom use behaviors. SMART Sex Ed shows promise as an effective sexual health education program for diverse AMSM.

Sexual minority status is associated with earlier recalled age of menarche: Evidence from the 2005-2016 National Health and Nutrition Examination Survey

INTRODUCTION

Menarcheal timing is associated with growth, development, health, wellbeing, and reproduction across the lifespan. Although sexual orientation is a known correlate of health and developmental inequities, relatively little evolutionarily framed research has investigated sexual orientation-based variation in maturational timing. To improve our understanding of menarcheal timing among sexual minority (SM) people, we use a biocultural-evolutionary life history lens that takes into account the stresses of minoritization to examine the relationship between sexual orientation and self-reported age at menarche in a sample of American adults.

METHODS

Using the U.S. National Health and Nutrition Examination Survey (NHANES), a large, nationally representative dataset (n = 9757), we fit multiple logistic regression models and survival curves to evaluate associations between sexual orientation, indicators of somatic and material resources during adolescence (e.g., education, citizenship, upper arm length), and self-reported menarche.

RESULTS

SM respondents were more likely to report earlier (by 4-5 months) ages of menarche (p < .001). Post-hoc tests revealed that these differences were driven by bisexual (p < .001) and same-sex experienced (p < .001) relative to heterosexual and lesbian/gay respondents. Earlier menarcheal timing among SM respondents persisted after adjusting for socio-demographic factors and proxies of developmental conditions.

DISCUSSION

Our findings reveal that SM status is associated with earlier ages of menarche, an important social and reproductive milestone. We argue that uniting life history theory with the minority stress hypothesis better explains differences in menarcheal timing by sexual orientation than previous paradigms. Investigators should attend to sexual orientation-based variation in maturational timing using holistic, inclusive approaches.

Web-Based Service Provision of HIV, Viral Hepatitis, and Sexually Transmitted Infection Prevention, Testing, Linkage, and Treatment for Key Populations: Systematic Review and Meta-analysis

BACKGROUND

Despite the growth of web-based interventions for HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) for key populations, the evidence for the effectiveness of these interventions has not been reported.

OBJECTIVE

This study aimed to inform the World Health Organization guidelines for HIV, VH, and STI prevention, diagnosis, and treatment services for key populations by systematically reviewing the effectiveness, values and preferences, and costs of web-based outreach, web-based case management, and targeted web-based health information for key populations (men who have sex with men, sex workers, people who inject drugs, trans and gender-diverse people, and people in prisons and other closed settings).

METHODS

We searched CINAHL, PsycINFO, PubMed, and Embase in May 2021 for peer-reviewed studies; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials (RCTs) and observational studies. We assessed the risk of bias using the Cochrane Collaboration tool for RCTs and the Evidence Project and Risk of Bias in Non-randomized Studies of Interventions tools for non-RCTs. Values and preferences and cost data were summarized descriptively.

RESULTS

Of 2711 records identified, we included 13 (0.48%) articles in the effectiveness review (3/13, 23% for web-based outreach; 7/13, 54% for web-based case management; and 3/13, 23% for targeted web-based health information), 15 (0.55%) articles in the values and preferences review, and 1 (0.04%) article in the costs review. Nearly all studies were conducted among men who have sex with men in the United States. These articles provided evidence that web-based approaches are as effective as face-to-face services in terms of reaching new people, use of HIV, VH, and STI prevention services, and linkage to and retention in HIV care. A meta-analysis of 2 RCTs among men who have sex with men in China found increased HIV testing after web-based outreach (relative risk 1.39, 95% CI 1.21-1.60). Among men who have sex with men in the United States, such interventions were considered feasible and acceptable. One cost study among Canadian men who have sex with men found that syphilis testing campaign advertisements had the lowest cost-per-click ratio on hookup platforms compared with more traditional social media platforms.

CONCLUSIONS

Web-based services for HIV, VH, and STIs may be a feasible and acceptable approach to expanding services to key populations with similar outcomes as standard of care, but more research is needed in low-resource settings, among key populations other than men who have sex with men, and for infections other than HIV (ie, VH and STIs).

Adolescent Perceptions of Technology-Based Sexual and Reproductive Health Services: A Systematic Review

Technology-based services, including telehealth, text messaging, and the internet are increasingly popular methods for adolescents and young adults (AYA) to access sexual and reproductive health (SRH) information and healthcare. This systematic review examined AYA perceptions of privacy and confidentiality of technology-based SRH services. The PubMed, Scopus, and PsycINFO were systematically searched in May 2021 to capture relevant qualitative or quantitative articles from the past 10 years. Included studies had AYA (i.e., mean age, 13-26-years with <10% of the sample outside this range), technology-based services for SRH, and outcomes of perceived privacy or confidentiality. Twenty-eight articles were included (N = 8638 AYA). Most studies utilized the internet and mobile apps to address human immunodeficiency virus infection (HIV), sexually transmitted infections, and general SRH topics. Most AYA reported that these services were private and confidential, with minimal differences across SRH topic addressed. More interactive services had greater concerns (e.g., family or friends seeing notifications). Most AYA considered technology-based SRH to be confidential and private. As technology will likely remain an integrated part of healthcare delivery, improving the privacy and confidentiality of these services can facilitate AYA's independent and autonomous engagement in SRH care, and potentially improve their SRH outcomes.

Sex Ed in the Post-Roe World: Implications for Public Health Education

The overturning of Roe v. Wade and the increasing assaults on lesbian, gay, bisexual, transgender, queer (LGBTQ+) rights in legislatures across the country have put our sexual and reproductive health in peril. They are likely also bellwethers of more to come. While a full reckoning of the repercussions from these attacks will not be known for a long time, the field of public health must act now with a strong and cohesive plan to mitigate the harms, fight these threats to our well-being, and lead the way forward.

Understanding Associations Between Exposure to Violent Pornography and Teen Dating Violence Among Female Sexual Minority High School Students

Previous research indicates that teen dating violence (TDV) is more common among sexual minority than heterosexual adolescents, with approximately half of female sexual minority adolescents (SMA) endorsing TDV victimization in the last year. In samples of adolescents without regard to sexual orientation, exposure to violent pornography is associated with TDV, but this relationship has not been assessed in female SMA. The current study sample consisted of 10th-grade high school students aged 14-17 who identified as cisgender females (N = 1,276). Data were collected from a baseline survey prior to the delivery of a sexual assault prevention intervention. Female SMA had 2.54 times the odds (95%CI [1.75, 3.69]) of being exposed to violent pornography and 2.53 times the odds (95%CI [1.72, 3.70)]) of TDV exposure compared to heterosexual girls. Exposure to violent pornography was not associated with involvement in TDV among female SMA, controlling for episodic heavy drinking (aOR = 2.25, 95%CI [0.88,6.22]).Given the relatively higher rates of violent pornography and TDV exposure among female SMA compared to heterosexual girls, it is critical that sex education curricula address these experiences and meet the needs of adolescents of all sexual orientations. Future research can assess how these TDV interventions might be tailored for female SMA. Although we did not find that exposure to violent pornography was associated with TDV among female SMA, these investigations should be replicated with larger data sets, given that the association between exposure to violent pornography and engagement in TDV was in the expected direction.

Developing an Unstructured Supplementary Service Data-based mobile phone app to provide adolescents with sexual reproductive health information: a human-centered design approach

BACKGROUND

Adolescent pregnancies and sexually-transmitted infections continue to impact 15 - 19-year-olds across the globe. The lack of sexual reproductive health information (SRH) in resource-limited settings due to cultural and societal attitudes towards adolescent SRH could be contributing to the negative outcomes. Innovative approaches, including mobile phone technologies, are needed to address the need for reliable adolescent SRH information.

OBJECTIVE

The study aimed to co-design a Unstructured Supplementary Service Data (USSD) based mobile app prototype to provide confidential adolescent SRH information on-demand and evaluate the mobile app's usability and user experience.

METHODS

A human-centered design methodology was applied. This practice framework allowed the perspectives and feedback of adolescent users to be included in the iterative design process. To participate, an adolescent must have been 15 to 19 years old, resided in Kibra and would be able to access a mobile phone. Adolescents were enrolled for the alpha and field testing of the app prototype at different time-points. The Mobile Application Rating Scale (MARS) a multidimensional mobile phone evaluation tool was used to access the functionality, engagement, aesthetics and quality of information in the app. Responses from the MARS were reported as mean scores for each category and a mean of the aggregate scores making the app's quality score. The MARS data was also evaluated as categorical data, A Chi square test of independence was carried out to show significance of any observed differences using cumulative and inverse cumulative distribution functions.

RESULTS

During the usability test, 62/109 (54.9%) of the adolescents that were followed-up had used the app at least once, 30/62 (48.4%) of these were male participants and 32/62 (51.6%) female. On engagement, the app had a mean score of 4.3/5 (SD 0.44), 4.6/5 (SD 0.38) on functionality, 4.3/5 (SD 0.57) on aesthetics and 4.4/5 (SD 0.60) on the quality of information. The overall app quality mean score was 4.4/5 (SD 0.31). The app was described as 'very interesting' to use by 44/62 (70.9%) of the participants, 20/44 males and 24/44 females. The content was deemed to be either 'perfectly' or 'well targeted' on sexual reproductive health by 60/62 (96.7%) adolescents, and the app was rated 'best app' by 45/62 (72.6%) adolescents, 27/45 females and 18/45 males, with a p-value = 0.011.

CONCLUSIONS

Adolescents need on-demand, accurate and trusted SRH information. A mobile phone app is a feasible and acceptable way to deliver adolescent SRH information in resource-limited settings. The USSD mobile phone technology shows promise in the delivery of much needed adolescent SRH information on-demand..

Use of digital media for family planning information by women and their social networks in Kenya: A qualitative study in peri-urban Nairobi

Access to information about family planning (FP) continues to have financial, physical and social barriers among young women living in Kenya. This paper draws on social norms theory to explore how young women and their social networks access FP information on digital media (e.g., WhatsApp, websites). Qualitative phone interviews were conducted with 40 participants - young women, their partners and key influencers - in seven peri-urban wards in Nairobi, Kenya. Data were analyzed using thematic analysis. Findings suggested that young women, their partners and key influencers predominately accessed FP information online through their informal networks, but identified healthcare workers as the most trusted sources of FP information. In digital spaces, participants described being more comfortable sharing FP information as digital spaces allowed for greater privacy and reduced stigma to talk about FP openly. Our findings highlight the importance of digital media in disseminating FP information among young women and their networks, the differences in norms governing the acceptability to talk about FP online vs. in-person and the significance of targeting misinformation about FP in digital media spaces.

Sexual and reproductive health knowledge, perceptions and experiences of women in Saudi Arabia: a qualitative study

BACKGROUND

There is no formal sexual and reproductive health (SRH) education currently offered in Saudi Arabia. Lack of knowledge and misconceptions are evident among Saudi women, which can lead to negative sexual and reproductive experiences. The aim of this study is to explore Saudi women's SRH knowledge, perceptions and experiences.

METHODS

Qualitative semi-structured interviews with Saudi women were conducted. Interviews took place in a public hospital in Riyadh, Saudi Arabia. Interviews were conducted in Arabic, recorded and transcribed verbatim, to allow for thematic analysis of the data. The following themes were identified: experience with menarche, deep-rooted negative views towards sex, difficulty discussing SRH topics, knowledge of sex and reproduction, generational gap, sources of SRH information and the role of the mother.

RESULTS

A total of 28 women, both married and unmarried, aged 20-50 years were interviewed. A profound lack of SRH knowledge was observed among Saudi women which contributed greatly to negative experiences both in childhood and adulthood. Lack of knowledge about menstruation often caused emotional distress for young girls, and menarche was associated with bad memories and negative emotions. Lack of knowledge about sexual intercourse and the deep-rooted negative views towards sex were linked with physical and psychological issues for women. Women rarely received information from their parents or teachers and preferred the internet for their SRH information.

CONCLUSION

There is a substantial unmet need for SRH education for women in Saudi Arabia. It is our recommendation that SRH education should be tailored to meet Saudi women's unique needs, while understanding specific socio-cultural barriers to SRH education and discussions. Research and policy efforts should be directed towards regulating and producing evidence-based health information on the internet, particularly Arabic language websites.

A mixed methods study of sexuality education experiences and preferences among bisexual, pansexual, and queer (bi+) male youth

Introduction

Bisexual male youth are more likely to engage in certain behaviors that contribute to HIV/STI transmission (e.g., substance use) than are heterosexual and gay male youth. However, sexuality education rarely addresses the unique needs of sexual minority youth, especially bisexual, pansexual, and queer (bi+) youth, and little is known about their sexuality education experiences and preferences. As such, the goal of this study was to examine bi+ male youth's experiences learning about sex and their preferences for sexuality education.

Methods

In 2019, 56 bi+ male youth ages 14-17 were surveyed and interviewed about their sexuality education experiences and preferences. Participants identified as bisexual (64%), pansexual (27%), and queer (9%), were racially/ethnically diverse (39% white, 32% Latinx, 20% Black, 9% other races), and included cisgender (79%) and transgender (21%) male youth.

Results

Participants described varied experiences with school-based sexuality education (e.g., none, abstinence only, covered sexual health in some way), but it rarely addressed their unique needs. They typically learned about sex by searching for information online and from sexually explicit media. Participants identified several topics they wanted to learn more about (e.g., sex with same-gender partners, anal sex, consent), but they typically believed they were prepared to have sex. Finally, some participants described benefits of tailoring sexuality education to their unique needs, while others described benefits of more inclusive programs.

Conclusions and Policy Implications

Findings suggest that bi+ male youth do not receive adequate sexuality education to make informed decisions about safer sex, highlighting the critical need for reform.

Facebook Doesn't Like Sexual Health or Sexual Pleasure: Big Tech's Ambiguous Content Moderation Policies and Their Impact on the Sexual and Reproductive Health of the Youth

This paper explores the modern challenges hindering access to sexual health resources in the age of Big Tech and their impact on public health. Research data from sexual health organizations, Internet experts, and corporate financial documents shows instances of conflict between Big Tech's business model and the sexual health organizations' efforts to provide accurate information about sexually transmitted diseases and unplanned pregnancy prevention to the youth. Results show that as younger generations turn to the internet for sexual health resources, they are met with misinformation and roadblocks, enabled by the dominant corporations in the market. Sexual pleasure, for instance, remains an overlooked dimension of these resources despite the fact that it is important to people. In conclusion, given the rise in popularity of tech platforms, and the youth's reliance on them as basic information resources, Big Tech must be held accountable for its role and impact on public health, and collaborative closely and actively with sexual health experts to establish appropriate content moderation policies for sexual health content online.

[Sexual health information on social media: a systematic scoping review]

BACKGROUND

Information on sexual and reproductive health is increasingly disseminated via social media and reaches a large audience.

RESEARCH AIM

Against this background, the aim of this paper is to systematically summarize the international state of research on sexual health information on social media for the first time with a scoping review. Seven research questions were explored, relating to the amount (F1), methods (F2: content analysis, F3: quality analysis), and results (F4: providers, F5: target groups, F6: topics, F7: quality of information) of previous studies.

MATERIALS AND METHODS

The study follows the PRISMA framework for scoping reviews as well as the Open Science approach. It is preregistered, and all materials (codebook with reliability coefficients) and data (list of identified studies and coding of studies) are available on the Open Science Foundation server.

RESULTS

A total of 69 studies with 72 data sets were identified, with more than half of the publications referring to YouTube (F1). Qualitative and quantitative methods of content analysis are used equally (F2) and quality analyses are rare (F3). Health laypersons dominate as the information providers (F4). The target groups are mostly unspecified (F5). The health information on social media examined in the previous studies covers a broad range of topics (F6). Where quality assessments were made, they tended to be negative (F7).

DISCUSSION

More research is needed to better understand sexual and reproductive health information on social media and to promote its quality and constructive use.

The Self-Identification, LGBTQ+ Identity Development, and Attraction and Behavior of Asexual Youth: Potential Implications for Sexual Health and Internet-Based Service Provision

While often included in the spectrum of sexual minority identities, asexuality receives comparatively little attention. Awareness and understanding remains limited, and knowledge has been generated primarily from adult populations. This paper employs a sample of 711 self-identified asexual youth (aged 14-24, M = 17.43 years) who identified as members of the LGBTQ+ community to consider the implications of a number of different areas for service provision. Two-thirds (66.8%) of participants identified as gender minorities within the spectrum of transgender and non-binary identities. Findings include aspects of participants' LGBTQ+ developmental processes, including that only 14.3% had disclosed their LGBTQ+ status to everyone in their lives. However, just 2.4% had disclosed to no one. Their attraction and sexual activity were also explored, with 27.1% having never experienced any kind of romantic or sexual attraction and 20.6% having ever been sexually active. Findings regarding participants' accessing of LGBTQ+ health information and engagement in a range of offline and online LGBTQ+ community activities are also provided. Participants acquired more health information online than offline-including sexual health information. Recommendations for service provision, particularly implications for sexual health and Internet-based services, are discussed.

Development, Implementation, and Effectiveness of a Self-sustaining, Web-Based LGBTQ+ National Platform: A Framework for Centralizing Local Health Care Resources and Culturally Competent Providers

Background

The lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) population has long faced substantial marginalization, discrimination, and health care disparities compared to the cisgender, heterosexual population. As the etiology of such disparities is multifaceted, finding concrete solutions for LGBTQ+ health care equity is challenging. However, the internet may offer the space to initiate an effective model.

Objective

In an effort to make LGBTQ+ public resources and culturally competent providers transparent, modernize medical education, and promote cultural competency, OutCare Health—a nonprofit 501(c)(3) multidisciplinary, multicenter web-based platform—was created.

Methods

The organization employs a cyclic, multidimensional framework to conduct needs assessments, identify resources and providers, promote these efforts on the website, and educate the next generation of providers. LGBTQ+ public health services are identified via the internet, email, and word of mouth and added to the Public Resource Database; culturally competent providers are recruited to the OutList directory via listservs, medical institutions, local organizations, and word of mouth; and mentors are invited to the Mentorship Program by emailing OutList providers. These efforts are replicated across nearly 30 states in the United States.

Results

The organization has identified over 500 public health organizations across all states, recognized more than 2000 OutList providers across all states and 50 specialties, distributed hundreds of thousands of educational materials, received over 10,000 monthly website visits (with 83% unique viewership), and formed nearly 30 state-specific teams. The total number of OutList providers and monthly website views has doubled every 12-18 months. The majority of OutList providers are trained in primary, first point-of-care specialties such as family medicine, infectious disease, internal medicine, mental health, obstetrics and gynecology, and pediatrics.

Conclusions

A web-based LGBTQ+ platform is a feasible, effective model to identify public health resources, culturally competent providers, and mentors as well as provide cultural competency educational materials and education across the country. Such a platform also has the opportunity to reach self-perpetuating sustainability. The cyclic, multidisciplinary, multidimensional, multicenter framework presented here appears to be pivotal in achieving such growth and stability. Other organizations and medical institutions should heavily consider using this framework to reach their own communities with high-quality, culturally competent care for the LGBTQ+ population.

Young Sexual Minority Women's Evaluation Processes of Online and Digital Sexual Health Information

Young sexual minority women (SMW) report worse sexual health outcomes in comparison to their heterosexual peers. One potential reason for this disparity could be SMW's lack of access to accurate and appropriate sexual health information. Many sexual minority youth report school-based sexual health curricula to be less useful than do heterosexual youth. As such, SMW may be more likely to seek sexual health information online. However, not all online sexual health information is relevant to the health needs of young SMW, and resources targeting SMW have been found to be lower in quality. Understanding more about how young SMW navigate and evaluate online sexual health resources is necessary to better identify their pathways of access to information. The current qualitative study addresses this issue through analyzing data from a series of focus groups with young SMW on their experiences of evaluating online sexual health information. The primary findings indicate that the young SMW in the current sample employ an extensive filtering system to identify the quality of any particular resource, and the criteria for these systems differ depending upon whether participants were seeking personal narratives or evidence-based information. Implications for sexual health information communication and interactions with healthcare providers are addressed.

Sexual Health Information Sources, Needs, and Preferences of Young Adult Sexual Minority Cisgender Women and Non-Binary Individuals Assigned Female at Birth

BACKGROUND

Young adult sexual minority women (SMW) have unique sexual health needs and higher rates of some poor sexual health outcomes compared to their heterosexual peers. Unequal access to relevant sexual health information may contribute to sexual orientation disparities in sexual health among women, but research on sexual health communication among SMW is sparse.

METHODS

In-depth interviews conducted in 2016-2017 investigated sexual health communication in a sample of 29 racially/ethnically diverse cisgender women and non-binary individuals assigned female at birth who were between 19 and 36 years of age and identified as a sexual minority. Data were analyzed using a thematic analysis approach that involved inductive and deductive coding to identify themes.

RESULTS

Three broad themes were identified: 1) sources of sexual health information; 2) sexual health information needs; and 3) preferences for sexual health information delivery. Participants discussed and critiqued the Internet, other mass media, health care providers, school-based sex education, family, and peers/partners as sources of sexual health information. Participants expressed a need for customized, non-heteronormative information pertaining to sexually transmitted infection risk and prevention. They preferred receiving information from health care providers, the Internet, and other mass media, and some also suggested school-based sex education and peer education as methods for delivering information.

CONCLUSIONS

Participants expressed clear desires for relevant, high-quality sexual health information delivered through a variety of channels, especially the Internet, other mass media, and health care providers.

POLICY IMPLICATIONS

Findings call for policies that improve provision of sexual health information through health care providers, online resources, and school-based sex education.

Online STI information seeking behaviour and condom use intentions among young Facebook users in Malaysia

The Internet has opened pathways for youth to find sexual health information which was not easily available to them in the past. Studies have shown that seeking sexual health information online may potentially influence an individuals' decision-making to change their sexual health behaviours. However, there is a gap in research on the associations of seeking online sexually transmitted infection (STI) information with STI prevention among young people, particularly in Malaysia. This study investigated the associations of seeking STI information online with the intentions of condom use among young adult online users in Malaysia. A cross-sectional online survey was conducted among Malaysian youth aged 18-25 years old who were recruited through Facebook. In total, 1530 respondents completed the survey, identifying 874 respondents who had sought STI information online. The majority of respondents had intentions to use condoms as protection against STI. Respondents who sought online STI information were significantly more likely to have the intention to use condoms compared to respondents who did not seek online STI information (OR = 1.33, 95% CI = 1.01-1.76, p = 0.040). Online STI information has the potential to increase access to STI information among young online users in Malaysia amid the stigma surrounding sex-related issues. Providing accurate STI information online from reliable sources may equip young people who have Internet access with awareness of sexual health protective behaviours such as condom use. It is recommended to facilitate Internet access to reach sectors of the population that currently do not have access, as the Internet is useful in STI prevention.

Pre-exposure Prophylaxis (PrEP) Information on Instagram: Content Analysis

Background

There is still an HIV epidemic in the United States, which is a substantial issue for populations bearing a disproportionate burden of HIV infections. Daily oral pre-exposure prophylaxis (PrEP) has proven to be safe and effective in reducing HIV acquisition risk. However, studies document that PrEP awareness/usage is low. There is also limited understanding of social media platforms, such as Instagram, as PrEP information sources.

Objective

Given the paucity of research on PrEP-related Instagram posts and popularity of this social media platform, the purpose of this research is to describe the source characteristics, image types, and textual contents of PrEP-related posts on Instagram.

Methods

Using Crowdtangle Search, a public insights tool owned/operated by Facebook, we retrieved publicly accessible and English-language-only Instagram posts for the 12-month period preceding April 22, 2020, using the following terms: Truvada or “pre-exposure prophylaxis” or #truvada or #truvadaprep or #truvadawhore or #truvadaforprep. We employed a qualitative coding methodology to manually extract information from posts. Using a pretested codebook, we performed content analysis on 250 posts, examining message and source characteristics (ie, organization type [eg, government, news] and individual type [eg, physician]), including information about PrEP (eg, how it works, cost), and indicated users. Frequencies and percentages were calculated for all categorical variables. A Chi-square test was conducted to determine differences between source types on a variety of message characteristics.

Results

Three-quarters of the posts (193/250, 77.2%) were posted by organizations. Of the 250 posts reviewed, approximately two-thirds (174/250, 69.6%) included a photograph, more than half (142/250, 56.8%) included an infographic, and approximately one-tenth (30/250, 12%) included a video. More than half defined PrEP (137/250, 54.8%), but fewer posts promoted PrEP use, explained how PrEP works, and included information on the effectiveness of PrEP or who can use it. The most commonly hashtagged populations among posts were men who have sex with men (MSM), but not necessarily bisexual men. Few posts contained race-/ethnicity-related hashtags (11/250, 4.4%). Fewer posts contained transgender-associated tags (eg, #transgirl; 5/250, 2%). No posts contained tags related to heterosexuals or injection drug users. We found statistical differences between source types (ie, individual versus organization). Specifically, posts from organizations more frequently contained information about who can use PrEP, whereas posts from individuals more frequently contained information describing adverse effects.

Conclusions

This study is among the first to review Instagram for PrEP-related content, and it answers the National AIDS Strategy’s call for a clearer articulation of the science surrounding HIV risk/prevention through better understanding of the current public information environment. This study offers a snapshot of how PrEP is being discussed (and by whom) on one of the most popular social media platforms and provides a foundation for developing and implementing PrEP promotion interventions on Instagram.

Characteristics of the health information seeking behavior of LGBTQ+ individuals: a systematic review on information types, information sources and influencing factors

Purpose

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) individuals' health information seeking is an important topic across multiple disciplines and areas. The aim of this systematic review is to create a holistic view of sexual and gender minority individuals' health information seeking reported in multidisciplinary studies, with regard to the types of health information LGBTQ+ individuals sought and information sources they used, as well as the factors influencing their health information seeking behavior.

Design/methodology/approach

The review is based on the literature search in 10 major academic databases. A set of inclusion and exclusion criteria was applied to identify studies that provide evidence on LGBTQ+ individuals' health information seeking behavior. The studies were first screened by title and abstract to determine whether they met the inclusion criteria. The full texts of each relevant study were obtained to confirm whether the exclusion criteria were met. The reference lists of the included studies were manually scanned. The relevant information was then extracted from selected articles and analyzed using thematic content analysis.

Findings

A seed set of 3,122 articles published between 1997 and 2020 was evaluated, and 46 total articles were considered for further analysis. The review results show that two major categories of health information sought by LGBTQ+ individuals were sexual and nonsexual, which were further classified into 17 specific types. In terms of health information sources, researchers have reported that online resources, interpersonal sources and traditional media were frequently used. Moreover, 25 factors affecting LGBTQ+ individuals' health information seeking were identified from the literature.

Originality/value

Through evidence-based understanding, this review preliminarily bridged the knowledge gap in understanding the status quo of studies on LGBTQ+ individuals' health information seeking and proposed the potential research directions that information science researchers could contribute to this important area.

Predicting Writing Styles of Web-Based Materials for Children's Health Education Using the Selection of Semantic Features: Machine Learning Approach

BACKGROUND

Medical writing styles can have an impact on the understandability of health educational resources. Amid current web-based health information research, there is a dearth of research-based evidence that demonstrates what constitutes the best practice of the development of web-based health resources on children's health promotion and education.

OBJECTIVE

Using authoritative and highly influential web-based children's health educational resources from the Nemours Foundation, the largest not-for-profit organization promoting children's health and well-being, we aimed to develop machine learning algorithms to discriminate and predict the writing styles of health educational resources on children versus adult health promotion using a variety of health educational resources aimed at the general public.

METHODS

The selection of natural language features as predicator variables of algorithms went through initial automatic feature selection using ridge classifier, support vector machine, extreme gradient boost tree, and recursive feature elimination followed by revision by education experts. We compared algorithms using the automatically selected (n=19) and linguistically enhanced (n=20) feature sets, using the initial feature set (n=115) as the baseline.

RESULTS

Using five-fold cross-validation, compared with the baseline (115 features), the Gaussian Naive Bayes model (20 features) achieved statistically higher mean sensitivity (P=.02; 95% CI -0.016 to 0.1929), mean specificity (P=.02; 95% CI -0.016 to 0.199), mean area under the receiver operating characteristic curve (P=.02; 95% CI -0.007 to 0.140), and mean macro F1 (P=.006; 95% CI 0.016-0.167). The statistically improved performance of the final model (20 features) is in contrast to the statistically insignificant changes between the original feature set (n=115) and the automatically selected features (n=19): mean sensitivity (P=.13; 95% CI -0.1699 to 0.0681), mean specificity (P=.10; 95% CI -0.1389 to 0.4017), mean area under the receiver operating characteristic curve (P=.008; 95% CI 0.0059-0.1126), and mean macro F1 (P=.98; 95% CI -0.0555 to 0.0548). This demonstrates the importance and effectiveness of combining automatic feature selection and expert-based linguistic revision to develop the most effective machine learning algorithms from high-dimensional data sets.

CONCLUSIONS

We developed new evaluation tools for the discrimination and prediction of writing styles of web-based health resources for children's health education and promotion among parents and caregivers of children. User-adaptive automatic assessment of web-based health content holds great promise for distant and remote health education among young readers. Our study leveraged the precision and adaptability of machine learning algorithms and insights from health linguistics to help advance this significant yet understudied area of research.

Using Machine Learning to Predict Young People's Internet Health and Social Service Information Seeking

Machine learning creates new opportunities to design digital health interventions for youth at risk for acquiring HIV (YARH), capitalizing on YARH's health information seeking on the internet. To date, researchers have focused on descriptive analyses that associate individual factors with health-seeking behaviors, without estimating of the strength of these predictive models. We developed predictive models by applying machine learning methods (i.e., elastic net and lasso regression models) to YARH's self-reports of internet use. The YARH were aged 14-24 years old (N = 1287) from Los Angeles and New Orleans. Models were fit to three binary indicators of YARH's lifetime internet searches for general health, sexual and reproductive health (SRH), and social service information. YARH responses regarding internet health information seeking were fed into machine learning models with potential predictor variables based on findings from previous research, including sociodemographic characteristics, sexual and gender minority identity, healthcare access and engagement, sexual behavior, substance use, and mental health. About half of the YARH reported seeking general health and SRH information and 26% sought social service information. Areas under the ROC curve (≥ .75) indicated strong predictive models and results were consistent with the existing literature. For example, higher education and sexual minority identification was associated with seeking general health, SRH, and social service information. New findings also emerged. Cisgender identity versus transgender and non-binary identities was associated with lower odds of general health, SRH, and social service information seeking. Experiencing intimate partner violence was associated with higher odds of seeking general health, SRH, and social service information. Findings demonstrate the ability to develop predictive models to inform targeted health information dissemination strategies but underscore the need to better understand health disparities that can be operationalized as predictors in machine learning algorithms.

Development and Evaluation of a Mobile App Designed to Increase HIV Testing and Pre-exposure Prophylaxis Use Among Young Men Who Have Sex With Men in the United States: Open Pilot Trial

BACKGROUND

HIV disproportionately affects young men who have sex with men (YMSM) in the United States. Uptake of evidence-based prevention strategies, including routine HIV testing and use of pre-exposure prophylaxis (PrEP), is suboptimal in this population. Novel methods for reaching YMSM are required.

OBJECTIVE

The aim of this study is to describe the development and evaluate the feasibility and acceptability of the MyChoices app, a mobile app designed to increase HIV testing and PrEP use among YMSM in the United States.

METHODS

Informed by the social cognitive theory, the MyChoices app was developed using an iterative process to increase HIV testing and PrEP uptake among YMSM. In 2017, beta theater testing was conducted in two US cities to garner feedback (n=4 groups; n=28 YMSM). These findings were used to refine MyChoices, which was then tested for initial acceptability and usability in a technical pilot (N=11 YMSM). Baseline and 2-month postbaseline assessments and exit interviews were completed. Transcripts were coded using a deductive approach, and thematic analysis was used to synthesize data; app acceptability and use data were also reported.

RESULTS

The MyChoices app includes personalized recommendations for HIV testing frequency and PrEP use; information on types of HIV tests and PrEP; ability to search for nearby HIV testing and PrEP care sites; and ability to order free home HIV and sexually transmitted infection test kits, condoms, and lube. In theater testing, YMSM described that MyChoices appears useful and that they would recommend it to peers. Participants liked the look and feel of the app and believed that the ability to search for and be pinged when near an HIV testing site would be beneficial. Some suggested that portions of the app felt repetitive and preferred using casual language rather than formal or medicalized terms. Following theater testing, the MyChoices app was refined, and participants in the technical pilot used the app, on average, 8 (SD 5.0; range 2-18) times over 2 months, with an average duration of 28 (SD 38.9) minutes per session. At the 2-month follow-up, the mean System Usability Scale (0-100) score was 71 (ie, above average; SD 11.8). Over 80% (9/11) of the participants reported that MyChoices was useful and 91% (10/11) said that they would recommend it to a friend. In exit interviews, there was a high level of acceptability for the content, interface, and features.

CONCLUSIONS

These data show the initial acceptability and user engagement of the MyChoices app. If future studies demonstrate efficacy in increasing HIV testing and PrEP uptake, the app is scalable to reach YMSM across the United States.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03179319; https://clinicaltrials.gov/ct2/show/NCT03179319.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/10694.

The Prevalence of Using Pornography for Information About How to Have Sex: Findings from a Nationally Representative Survey of U.S. Adolescents and Young Adults

We analyzed cross-sectional data collected from a U.S. nationally representative survey of individuals ages 14-24 years old on what sources of information from the past year they considered to be the most helpful about how to have sex (n = 600 adolescents ages 14-17 years old, and n = 666 young adults ages 18-24 years old). Among the 324 adolescents who indicated that they had been helped by at least one source of information, helpful information was most likely to have come from parents (31.0%) and friends (21.6%). Only 8.4% of adolescents said pornography was helpful. However, for those in the 18-24-year-old age group, pornography was the most commonly endorsed helpful source (24.5%), as compared to other possible options such as sexual partners, friends, media, and health care professionals. Multivariable regression analyses revealed that indicating that pornography was the most helpful source of information about how to have sex, compared to the other sources, was inversely associated with being female (OR = 0.32, p = .001), inversely associated with identifying as bisexual compared to heterosexual (OR = 0.15, p = .038), positively associated with being Black compared to being white non-Hispanic (OR = 4.26, p = .021), inversely associated with reporting a household income of either $25 K to $49,999 (OR = 0.31, p = .010) or $50 K to $74,999 (OR = 0.36, p = .019) compared to more than $75 K, and positively associated with having masturbated (OR = 13.20, p = .005). Subsequent research should investigate the role of pornography in both adolescent and adult sexual development, including why one-quarter of U.S. young adults say that pornography is a helpful source of information about how to have sex and what they think that they are learning from it.

Use of media sources in seeking and receiving sexual health information during adolescence among adults of diverse sexual orientations in a US cohort

The objective in this study was to examine the association between sexual orientation and seeking/receiving sexual and reproductive health (SRH) information from media sources during adolescence. We analysed data from male and female participants (aged 23-35 years) from the U.S.-based Growing Up Today Study (GUTS) in 2016. Sex-stratified, multivariable log-binomial models adjusted for age, cohort and race/ethnicity were used to examine sexual orientation differences in retrospective self-reported seeking/receipt of SRH media information before age 18. Sexual minority (e.g., mostly heterosexual, bisexual, gay) men and women were more likely than same-gender individuals who identified as completely heterosexual to seek/receive SRH information about contraceptive methods (e.g., condom use), sexually transmitted infections, and HIV and AIDS. Although lesbians were more likely than completely heterosexuals to seek/receive SRH information from media about each topic, they were the sexual minority subgroup with the smallest proportion seeking/receiving SRH information. Sexual minorities may passively and/or actively receive SRH information pertaining to a wide range of topics, including skills-based sex education, from media sources more frequently than heterosexuals, which may influence safe-sex decision-making. Lesbians in particular may benefit from media information dissemination focusing on their specific SRH needs, as current media sources do not seem to be well-utilised by this group.

Expert Opinions on Web-Based Peer Education Interventions for Youth Sexual Health Promotion: Qualitative Study

Background

Participatory education, in the form of peer education, may be an effective way to promote youth sexual health. With the advent of the internet, web-based interventions have potential as an attractive new tool for sexual health promotion by peers.

Objective

The aim of this study was to evaluate professional experts’ opinions on the perspectives for web-based participatory interventions to promote sexual health by peers and among young people.

Methods

Semistructured interviews were carried out with 20 experts (stakeholders in direct contact with young people, researchers, and institutional actors) specializing in sexual health, health promotion, peer education, youth, internet, and social media. After coding with N’Vivo, data were subjected to qualitative thematic analysis.

Results

The majority of experts (18/20, 90%) found this kind of intervention to be attractive, but highlighted the necessary conditions, risks, and limitations attached to developing an acceptable peer intervention on the internet for sexual health promotion among young people. Five main themes were identified: (1) an internet intervention; (2) sexual health; (3) internet skills, and uses and the need for moderation; (4) multifaceted peers; and (5) minority peers. In the absence of youth interest for institutional messages, the experts highlighted the attractive participatory features of web-based interventions and the need for geolocalized resources. However, they also warned of the limitations associated with the possibility of integrating peers into education: peers should not be mere messengers, and should remain peers so as not to be outsiders to the target group. Experts highlighted concrete proposals to design an online participatory peer intervention, including the process of peer implication, online features in the intervention, and key points for conception and evaluation.

Conclusions

The experts agreed that web-based participatory interventions for youth sexual health promotion must be tailored to needs, uses, and preferences. This type of action requires youth involvement framed in an inclusive and holistic sexual health approach. Peer education can be implemented via the internet, but the design of the intervention also requires not being overly institutional in nature. Involving young people in their own education in an interactive, safe online space has the potential to develop their empowerment and to foster long-term positive behaviors, especially in the area of sexual health.

Predictors of Internet Health Information-Seeking Behaviors Among Young Adults Living With HIV Across the United States: Longitudinal Observational Study

BACKGROUND

Consistent with young adults' penchant for digital communication, young adults living with HIV use digital communication media to seek out health information. Understanding the types of health information sought online and the characteristics of these information-seeking young adults is vital when designing digital health interventions for them.

OBJECTIVE

This study aims to describe characteristics of young adults living with HIV who seek health information through the internet. Results will be relevant to digital health interventions and patient education.

METHODS

Young adults with HIV (aged 18-34 years) self-reported internet use during an evaluation of digital HIV care interventions across 10 demonstration projects in the United States (N=716). Lasso (least absolute shrinkage and selection operator) models were used to select characteristics that predicted whether participants reported seeking general health and sexual and reproductive health (SRH) information on the internet during the past 6 months.

RESULTS

Almost a third (211/716, 29.5%) and a fifth (155/716, 21.6%) of participants reported searching for general health and SRH information, respectively; 26.7% (36/135) of transgender young adults with HIV searched for gender-affirming care topics. Areas under the curve (>0.70) indicated success in building models to predict internet health information seeking. Consistent with prior studies, higher education and income predicted health information seeking. Higher self-reported antiretroviral therapy adherence, substance use, and not reporting transgender gender identity also predicted health information seeking. Reporting a sexual orientation other than gay, lesbian, bisexual, or straight predicted SRH information seeking.

CONCLUSIONS

Young adults living with HIV commonly seek both general health and SRH information online, particularly those exploring their sexual identity. Providers should discuss the most commonly sought SRH topics and the use of digital technology and be open to discussing information found online to better assist young adults with HIV in finding accurate information. Characteristics associated with health information-seeking behavior may also be used to develop and tailor digital health interventions for these young adults.

Using Intervention Mapping to Developmentally Adapt an Online HIV Risk Reduction Program for Adolescent Men Who Have Sex with Men

Adolescent men who have sex with men (AMSM) experience a dramatic health disparity in HIV, accounting for over 80% of new diagnoses among youth. Current evidence-based HIV prevention programs, however, focus primarily on adults and heterosexual youth, thereby missing the unique experiences and socio-environmental contexts of AMSM aged 13-18. To address these gaps, we used the Intervention Mapping (IM) protocol to developmentally adapt an existing evidence-based online HIV risk reduction program (i.e., Keep it Up!/KIU!), originally designed for young adult MSM aged 18-29, into a new intervention called SMART Squad. Using a hybrid of IM creation and adaptation tasks, we specified three behavioral outcomes and identified corresponding performance objectives for SMART Squad based on the original goals of KIU!. We constructed matrices of change objectives using determinants from the Information-Motivation-Behavioral Skills model, modifying them for the younger population with additional theoretical and empirical evidence and expert review. SMART Squad activities were operationalized from theory-based behavior change methods matched to the change objectives and guided by program themes, components, and scope imported from KIU!. The final SMART Squad intervention comprises 6 episodes/modules delivered in 2 sessions plus 2 booster episodes occurring 1 and 3 months after the main program. It is currently being evaluated nationally as part of a stepped-care package of 3 programs, in which the receipt and sequencing of interventions is tailored to individual AMSM development and needs. Despite substantial changes to KIU!, IM was a useful method for retaining the hypothesized essential elements of the eHealth HIV risk reduction program. Challenges and recommendations for future researchers and practitioners are discussed.

Real-World Evidence on the Effect of Missing an Oral Contraceptive Dose: Analysis of Internet Search Engine Queries

Background

Oral contraceptives (OCs) are a unique chronic medication with which a memory slip may result in a threat that could change a person’s life course. Subjective concerns of missed OC doses among women have been addressed infrequently. Anonymized queries to internet search engines provide unique access to concerns and information gaps faced by a large number of internet users.

Objective

We aimed to quantitate the frequency of queries by women seeking information in an internet search engine, after missing one or more doses of an OC; their further queries on emergency contraception, abortion, and miscarriage; and their rate of reporting a pregnancy timed to the cycle of missing an OC.

Methods

We extracted all English-language queries submitted to Bing in the United States during 2018, which mentioned a missed OC and subsequent queries of the same users on miscarriage, abortion, emergency contraceptives, and week of pregnancy.

Results

We identified 26,395 Bing users in the United States who queried about missing OC pills and the fraction that further queried about miscarriage, abortion, emergency contraceptive, and week of pregnancy. Users under the age of 30 years who asked about forgetting an OC dose were more likely to ask about abortion (1.5 times) and emergency contraception (1.7 times) (P<.001 for both), while users at ages of 30-34 years were more likely to query about pregnancy (2.1 times) and miscarriage (5.4 times) (P<.001 for both).

Conclusions

Our data indicate that many women missing a dose of OC might not have received sufficient information from their health care providers or chose to obtain it online. Queries about abortion and miscarriage peaking in the subsequent days indicate a common worry of possible pregnancy. These results reinforce the importance of providing comprehensive written information on missed pills when prescribing an OC.

Mobile sex-tech apps: How use differs across global areas of high and low gender equality

Digital technologies are increasingly intertwined into people's sexual lives, with growing scholarly interest in the intersection of sex and technology (sex-tech). However, much of the literature is limited by its over emphasis on negative outcomes and the predominance of work by and about North Americans, creating the impression that sex-tech is largely a Western phenomenon. Based on responses from 130,885 women in 191 countries, we assessed how women around the world interact with mobile technology for sex-related purposes, and whether in areas of greater gender inequality, technological accessibility may be empowering women with knowledge about sexuality. We investigated women's use of technology to find sexual partners, learn about sex and improve their sexual relationships, and track their own sexual health. About one-fifth reported using mobile apps to find sexual partners. This use varied by region: about one-third in Oceania, one-fourth in Europe and the Americas, and one-fifth in Asia and Africa. Staying connected when apart was the most commonly selected reason for app use with a sexual partner. About one-third had used an app to track their own sexual activity. Very few reported that the app they used to improve their sexual relationships was detrimental (0.2%) or not useful (0.6%). Women in countries with greater gender inequality were less likely to have used mobile apps to find a sexual partner, but nearly four times more likely to have engaged in sending and receiving sexts. To our knowledge, this study provides the most comprehensive global data on sex-tech use thus far, demonstrates significant regional variations in sex-tech use, and is the first to examine women's engagement in sex-related mobile technology in locations with greater gender disparities. These findings may inform large-scale targeted studies, interventions, and sex education to improve the lives of women around the world.

Evaluating the Effectiveness of an Intervention Integrating Technology and In-Person Sexual Health Education for Adolescents (In the Know): Protocol for a Cluster Randomized Controlled Trial

Background

Access to a smartphone is nearly universal among American adolescents, and most of them have used the internet to seek health information. Integrating digital technologies into health program delivery may expand opportunities for youth to receive important health information, yet there are few rigorous studies assessing the effectiveness of this type of intervention.

Objective

The purpose of this study is to assess the effectiveness of In the Know (ITK), a program integrating in-person and technology-based sexual health education for underserved adolescents.

Methods

Youth were engaged in the development of the intervention, including the design of the digital technology and the curriculum content. The intervention focuses on 3 main areas: sexual health and contraceptive use, healthy relationships, and educational and career success. It includes an in-person, classroom component, along with a web-based component to complement and reinforce key content. A cluster randomized controlled trial is in progress among adolescents aged 13-19 years living in Fresno County, California. It is designed to examine the differences in self-reported health and behavioral outcomes among youth in the intervention and control groups at 3 and 9 months. Primary outcomes are condom and contraceptive use or no sex in the past 3 months and use of any clinical health services in the past 3 months. Secondary outcomes include the number of sexual partners in the past 3 months and knowledge of local clinical sexual health services. We will use mixed-effects linear and logistic regression models to assess differences between the intervention and control groups.

Results

Trial enrollment began in October 2017 and ended in March 2020 with a total of 1260 participants. The mean age of the participants is 15.73 (SD 1.83) years, and 69.98% (867/1239) of the participants report being Hispanic or Latino. Study results will be available in 2021.

Conclusions

ITK has the potential to improve contraceptive and clinic use among underserved youth. This trial will inform future youth-focused health interventions that are considering incorporating technology.

International Registered Report Identifier (IRRID)

DERR1-10.2196/18060

Young Bisexual People's Experiences of Sexual Violence: A Mixed-Methods Study

Bisexual people are at an increased vulnerability for sexual victimization in comparison to heterosexual people, as well as gay and lesbian people. As the majority of first sexual violence experiences happen prior to age 25 for bisexual women, young bisexual people are particularly vulnerable. Despite consistent evidence of this health disparity, little is known about what factors might increase young bisexual people's risk for sexual victimization, or how they access support post-victimization. The current study addresses this gap through a mixed-method investigation of young bisexual people's experiences of sexual violence with a sample of 245 bisexual people age 18-25. Quantitative results indicate that bisexual stigma significantly predicts a greater likelihood of reporting an experience of sexual violence. Qualitative findings support that while not all participants felt bisexual stigma related to their experience of sexual violence, some felt negative bisexual stereotypes were substantial factors. Interview participants found connecting with other survivors, particularly LGBTQ+ and bisexual survivors, to be beneficial. Some participants encountered barriers to accessing support, such as discrimination in schools. Sexual violence researchers should consider bisexual stigma as an important factor, and support services the potential positive impact of bisexual-specific survivor support.

Innovation and Integration of Sexuality in Family Life Education

As a fundamental aspect of the human experience, sexuality is experienced at every stage in the lifespan. Sexual values, behaviors, and health are important components of individual and family well-being. Educating about such a fundamental aspect of life is both obvious and crucial. In this article, we consider the potential of sexuality education in the field and profession of family life education (FLE). We critique sexuality education in the United States, and we critique the marginal place of human sexuality in the FLE field. We then offer recommendations for incorporating lifespan, socio-ecological, family systems and intersectionality into sexuality education, and recommendations for FLE and sexuality education research and practice. We argue that educating about sexuality in the context of FLE-and activating the profession of FLE for sexuality education-will strategically advance sexuality education, sexual health, and the field of FLE.

A Digital Pornography Literacy Resource Co-Designed With Vulnerable Young People: Development of "The Gist"

BACKGROUND

The impact of viewing pornography at a young age on the sexual health of subgroups of young people is an important public health issue. However, the topic is complex and extremely sensitive, and best practices for research and harm reduction are yet to be defined. Drawing on cross-disciplinary approaches, such as co-design, is one way to achieve a better understanding of the issue among vulnerable young people and to create needs-based and evidence-informed digital resources to promote pornography literacy.

OBJECTIVE

The objective of this study was to co-design a relevant, usable, and acceptable digital prototype to address the pornography literacy needs of vulnerable young people.

METHODS

In total, 17 young people aged between 14 and 23 years who were engaged in youth services programs or alternative education programs were recruited to participate in 4 co-design workshops with a multidisciplinary design team.

RESULTS

Although the participants could identify problems with pornography and critique its messages, they lacked the information to understand alternative healthy attitudes and behaviors. A digital resource that provides detailed and practical information about sex, sexual ethics, and relationships may help vulnerable young people to identify and contrast with any problematic messages they receive from both pornography and society. Embedding this information with pornography literacy messages may be a more effective way of addressing underlying attitudes. Acknowledging information-seeking patterns and leveraging user interaction patterns from commonly used digital platforms among users may enhance engagement with resources. Importantly, digital platforms are perceived among this group as a source of anonymous secondary information but would not be organically accessed among this group without face-to-face conversations as an access point.

CONCLUSIONS

This paper highlights the potential for pornography literacy to be embedded within real and practical information about having sex, navigating sexuality, and healthy relationships. The study findings include important recommendations for the conceptualization of digital pornography literacy programs and opportunities for cross-disciplinary co-design research to address complex and emerging health issues.

Examining Peer-to-Peer and Patient-Provider Interactions on a Social Media Community Facilitating Ask the Doctor Services

Ask the Doctor (AtD) services provide patients the opportunity to seek medical advice using online platforms. While these services represent a new mode of healthcare delivery, study of these online health communities and how they are used is limited. In particular, it is unknown if these platforms replicate existing barriers and biases in traditional healthcare delivery across demographic groups. We present an analysis of AskDocs, a subreddit that functions as a public AtD platform on social media. We examine the demographics of users, the health topics discussed, if biases present in offline healthcare settings exist on this platform, and how empathy is expressed in interactions between users and physicians. Our findings suggest a number of implications to enhance and support peer-to-peer and patient-provider interactions on online platforms.

Provision of online HIV-related information to gay, bisexual and other men who have sex with men: a health literacy-informed critical appraisal of Canadian agency websites

Background HIV risk and prevention information is increasingly complex and poses challenges for gay, bisexual and other men who have sex with men (GBMSM) seeking to find, understand and apply this information. A directed content analysis of Canadian HIV websites to see what information is provided, how it is presented and experienced by users, was conducted.

METHODS

Eligible sites provided information relevant for GBMSM on HIV risk or prevention, were from community or government agencies, and were aimed at the public. Sites were found by using a Google search using French and English search terms, from expert suggestions and a review of links. Eligibility and content for review was determined by two reviewers, and coded using a standardised form. Reading grade level and usability scores were assessed through Flesch-Kincaid and LIDA instruments.

RESULTS

Of 50 eligible sites, 78% were from community agencies and 26% were focussed on GBMSM. Overall, fewer websites contained information on more recent biomedical advances (e.g. pre-exposure prophylaxis, 10%) or community-based prevention strategies (e.g. seroadaptive positioning, 10%). Many sites had high reading levels, used technical language and relied on text and prose. And 44% of websites had no interactive features and most had poor usability scores for engageability.

CONCLUSIONS

Overall, less information about emerging topics and a reliance on text with high reading requirements was observed. Our study speaks to potential challenges for agency website operators to maintain information relevant to GBMSM which is up-to-date, understandable for a range of health literacy skills and optimises user experience.

Project Moxie: Results of a Feasibility Study of a Telehealth Intervention to Increase HIV Testing Among Binary and Nonbinary Transgender Youth

Transgender youth have low rates of engagement in HIV prevention, shaped in part by experiences of transphobia and lack of access to culturally competent care. Project Moxie tested the feasibility of an intervention that provides home-based HIV self-testing coupled with video-chat counseling. A diverse sample of 202 binary and nonbinary transgender youth (TY) were recruited online, and randomized 2:1 to receive the intervention or a control condition of only home-based HIV self-testing. TY were willing to order HIV self-testing kits and report their results. Half of those in the intervention arm opted to use the video-chat counseling and, among those who did, levels of satisfaction were high. Project Moxie demonstrates the ability to recruit TY online and provide them with access to home HIV testing. Further work is required to develop online interventions for youth who do not wish to receive counseling through video-chat formats.

Health information seeking behaviour: a concept analysis

BACKGROUND

In 2007, Lambert and Loiselle conducted an extensive concept analysis of the term health information seeking behaviour (HISB) to examine the concept's level of maturity and critically analyse its characteristics. Since their groundbreaking work, HISB has evolved with the proliferation of ICTs. The Internet is now a common and often preferred medium for the pursuit of health information.

OBJECTIVES

The previous analysis spanned 42 years of literature; this article describes an analysis of the last 10 years of literature on HISB and how online seeking has caused the concept to evolve in the literature.

METHODS

This study used the concept analysis methodology employed by Lambert and Loiselle in the original analysis. It also included a systematic search conducted in five databases to identify studies from 2007 to 2017, using similar inclusion criteria from the original study.

RESULTS

Of the more than 500 articles retrieved, 85 journal articles met the inclusion criteria. Consistent with the original work, articles that included outcomes were identified as either behavioural or cognitive.

CONCLUSION

Most of the attention of the works studied focused on individuals and their information source preferences. This HISB analysis can be incorporated with studies to understand how various communities seek information in online versus non-online contexts.

Sexuality Education in the Digital Era: Intrinsic and Extrinsic Predictors of Online Sexual Information Seeking Among Youth

This study aimed to identify demographic, intrinsic and extrinsic predictors of youth's online sexual information seeking. We used survey data from a large, representative sample of youth (12-24 years) in the Netherlands (N = 20,500). We focused on online sexual information seeking in general, and on two specific types of online sources: interactive user-generated content (UGC) and professional sexuality education content. Findings suggested that LGB youth and youth with more sexual knowledge were more likely to consult sexual information online, both via UGC and via professional websites about sex. Professional content specifically reaches female youth more than male youth, and is more likely to be consulted by youth with more sexual experience and sexual problems. Further, being male, having low sexual esteem and high sexual curiosity were linked to a higher use of interactive UGC. Finally, only communication with friends about sex, but not with parents or partners, nor the amount and appreciation of school-based sexuality education received, was related to a higher use of online sexual information seeking, notably expert sources of sexual information.

Sexual and Reproductive Health Web Sites: An Analysis of Content for Sexual and Gender Minority Youth

PURPOSE

Sexual and gender minority (SGM) youth face risks for negative sexual and reproductive health (SRH) outcomes; it is critical to provide these populations with health education that is both inclusive of and specific to their needs. We sought to characterize the strengths and weaknesses of SGM-related messages from web sites that address SRH for young people. We considered who is included, what topics are discussed, and how messages are framed.

METHODS

A systematic Google search and screening process was used to identify health promotion web sites with SRH content for adolescents and young adults. Using MAXQDA, we thematically coded and analyzed SGM content qualitatively.

RESULTS

Of 32 SRH web sites identified, 23 (71.9%) contained SGM content. Collectively, the sites included 318 unique SGM codes flagging this content. Approximately two-thirds of codes included messages that discussed SGM youth in aggregate (eg, lesbian, gay, bisexual, and transgender)-specific content about the diverse subpopulations within this umbrella term (eg, transgender youth) was more limited. In addition to SRH topics, most web sites had messages that addressed a broad array of other health issues including violence, mental health, and substance use (n = 17, 73.9%) and SGM-specific topics, for example coming out (n = 21, 91.3%). The former were often risk-framed, yet affirmational messages were common. Most web sites (n = 16; 69.6%) presented information for SGM youth both in stand-alone sections and integrated into broader content. Yet, integrated information was slightly more common (56.6% of all codes) than stand-alone content.

CONCLUSIONS

Challenges of developing SRH content related to SGM youth include: (1) aggregate terms, which may not represent the nuances of sexual orientation and gender, (2) balancing risk versus affirmational messages, and (3) balancing stand-alone versus integrated content. However, SGM-related content also offers an opportunity to address diverse topics that can help meet the needs of these populations.