School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT

Background

The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization.

Objectives

To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes.

Design

A cluster randomised trial, incorporating health economics and process evaluations.

Setting

Sixty-six schools across the four nations of the UK.

Participants

Students aged 13-14 years.

Intervention

A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE.

Main outcome measures

Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12-14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours.

Results

The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI -£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI -£15.60 to -£3.83).

Limitations

The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01).

Conclusions

We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12-14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective.

Future work

Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings.

Trial registration

This trial is registered as ISRCTN10751359.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information.

Parents’ approaches to sexuality education of their adolescent boys: a qualitative study in Ahvaz, Iran

Background

Despite its important role in adolescent sexual health, sexuality education remains one of the most challenging responsibilities of families, especially those living in Muslim communities which experience the transition to modernity. There is little information about sexuality education of boys in Iran. This study aimed to explore parents’ approaches to sexuality education of adolescent boys in Ahvaz, southwest of Iran.

Methods

This qualitative study was conducted in 2017 in Ahvaz, Iran. Participants were selected through purposeful sampling with maximum variation. Qualitative data were collected by conducting semi-structured in-depth interviews and focused group discussions with 27 parents from middle/high social class who had adolescent boys aged between 10 and 19. Data were analyzed using conventional qualitative content analysis.

Results

Parents’ approaches to sexuality education of their boys emerged in six categories: Extreme monitoring and restricting; abstinence as the main content of sexuality education; struggling to establish peace and achieve tolerance; criticizing the cultural taboos; hoping for spontaneous learning; and uncertainty and confusion. The theme “Transition from tradition to modernity” emerged from these categories.

Conclusion

Parents’ approaches to sexuality education ranged from a restrictive traditional manner to approaches with some degree of modern attitudes. Parents are facing uncertainty and confusion regarding sexuality education. Abstinence is an underlying assumption in their sexuality education style. Educating parents through culturally-appropriate methods is a priority that is more acceptable at the policy level. Lack of understanding of the need for sexuality education of children in some parents can threaten the sexual health of children.

Children’s sexuality education has an important role in adolescent sexual behaviors and health. However, it is one of the most challenging dimensions of education in families, especially in Muslim communities experiencing the transition to modernity. There is little information about sexuality education of adolescent boys in Iran. In this study we aimed to explore parents’ experiences and perceptions of communicating sexuality education with their sons. Data were collected through individual interview with 11 parents and group discussion with 8 fathers and 8 mothers who had sons aged 10–19, living in Ahvaz, in south west of Iran. We summarized and categorized parents’ approaches to sexuality education in categories including: Extreme monitoring and restricting; abstinence as the main content of sexuality education; struggling to establish peace and achieve tolerance; criticizing the cultural taboos; hoping for spontaneous learning; and uncertainty and confusion. Parents’ approaches to sexuality education ranged from a restrictive traditional manner to some degree of modern conduct. Findings imply that parents are facing challenges regarding sexuality education: uncertainty about the necessity of it, and confusion between religious teachings and modernity. Abstinence is still a central assumption and pre-marital sex is off-limits in their sexuality education. They hoped that they could enhance the children’s adherence to family’s values regarding sexuality, by establishing a peaceful relationship with them. These findings provide evidence for culturally-appropriate educational programs for parents to improve their skills and knowledge about sexuality education. These findings highlighted the fact that Iranian parents are experiencing a “Transition from tradition to modernity”.

Examining the Information Systems Success (ISS) of a mobile sexual health app (MyPEEPS Mobile) from the perspective of very young men who have sex with men (YMSM)

OBJECTIVE

The widespread and frequent use of mobile technology among adolescents, including sexual minority adolescents, presents an opportunity for the development of mobile health (mHealth) technology to combat the continuing HIV epidemic among young men who have sex with men (YMSM). We analyzed perceptions of the quality and impact of an HIV prevention mobile app on sexual risk reduction among YMSM.

METHODS

Participants were recruited from a larger randomized controlled trial of the MyPEEPS Mobile app among YMSM aged 13-18 years. Data were collected via semi-structured interviews to assess quality and user satisfaction with MyPEEPS Mobile app using analysis informed by the Information Systems Success framework. Interview data were transcribed verbatim and analyzed using six themes: information quality, net benefit, user satisfaction, product quality, service quality, and health care barriers.

RESULTS

Interviews were conducted with 40 YMSM (45% Hispanic; 80% non-White; 88% non-rural resident; 28% aged 17 years). Participants' responses indicated that information quality was high, reporting that the app information was concise, easy to understand, useful, and relevant to their life. The net benefits were stated as improvements in their decision-making skills, health behaviors, communication skills with partner(s), and increased knowledge of HIV risk. There was general user satisfaction and enjoyment when using the app, although most of the participants did not intend to reuse the app unless new activities were added. Participants expressed that the product quality of the app was good due to its personalization, representation of the LGBTQIA + community, and user-friendly interface. Although no major technical issues were reported, participants suggested that adaption to a native app, rather than a web app, would improve service quality through faster loading speed. Participants also identified some health care barriers that were minimized by app use.

CONCLUSIONS

The MyPEEPS Mobile app is a well received, functional, and entertaining mHealth HIV prevention tool that may improve HIV prevention skills and reduce HIV risk among YMSM.

Association between number of sexual partners and utilization of family planning and sexually transmitted infection services by men aged 15-44 in the United States

Unintended pregnancy and sexually transmitted infections (STIs) pose a huge public health problem in the United States. Efforts towards reducing unintended pregnancies have previously focused on women, but the role of men in family planning and preventing unwanted pregnancy is becoming clearer. The primary objective of the study was to fully examine the utilization of family planning services by men in the US, and to determine whether factors such as race, health insurance type and number of sexual partners influenced their utilization and receipt of family planning services and STI-related health services. Data were from the 2006-2010 National Survey on Family Growth (NSFG) study conducted in the US. The study sample comprised 7686 men aged 14-44 who ever had sex with women, and who had had at least one sexual partner in the 12 months before the survey. The receipt of family planning and STI-related health services by this group of men was estimated. The results showed that non-Hispanic Black men were more likely to receive family planning and STI-related services than Hispanic and non-Hispanic White males. Given that non-Hispanic Black men are disproportionately affected by STIs and are a high-risk group, the finding that this group received more family planning and STI services is a positive step towards reducing the disproportionately high prevalence of STIs in men in this under-privileged population.

Advocating for Adolescent and Young Adult Male Sexual and Reproductive Health: A Position Statement From the Society for Adolescent Health and Medicine

There is a critical need to improve the sexual and reproductive health (SRH) education and care of adolescent and young adult (AYA) males around the globe, as SRH is a basic human right for all AYAs. This special attention toward the SRH of AYA males is warranted given the fact that they often have difficulty accessing SRH services and education relative to their female counterparts and have higher rates of sexual risk behaviors than females. To promote AYA males' SRH and the health of their sexual partners and children, the Society for Adolescent Health and Medicine (SAHM) recommends that leaders in research, policy, public health, and clinical practice develop and implement evidence-based, comprehensive SRH education that supports AYA males at school, within communities and families, and through healthcare services that are developmentally appropriate, gender affirming, inclusive of, and informed by AYA males. Additionally, SAHM recommends that healthcare systems and healthcare professionals (HCPs) across disciplines establish and implement competencies for SRH education and skills preparation to meet the unique needs of AYA males across diverse healthcare and community settings. This statement examines multilevel barriers that AYA males face in accessing comprehensive SRH education and services and makes recommendations aligned with the World Health Organization's 2030 Sustainable Development Goals to address such barriers, improve AYA male SRH, and promote overall gender equity in SRH services.

JACK trial protocol: a phase III multicentre cluster randomised controlled trial of a school-based relationship and sexuality education intervention focusing on young male perspectives

INTRODUCTION

Teenage pregnancy remains a worldwide health concern which is an outcome of, and contributor to, health inequalities. The need for gender-aware interventions with a focus on males in addressing teenage pregnancy has been highlighted as a global health need by WHO and identified in systematic reviews of (relationship and sexuality education (RSE)). This study aims to test the effectiveness of an interactive film-based RSE intervention, which draws explicit attention to the role of males in preventing an unintended pregnancy by reducing unprotected heterosexual teenage sex among males and females under age 16 years.

METHODS AND ANALYSIS

A phase III cluster randomised trial with embedded process and economic evaluations. If I Were Jack encompasses a culturally sensitive interactive film, classroom materials, a teacher-trainer session and parent animations and will be delivered to replace some of the usual RSE for the target age group in schools in the intervention group. Schools in the control group will not receive the intervention and will continue with usual RSE. Participants will not be blinded to allocation. Schools are the unit of randomisation stratified per country and socioeconomic status. We aim to recruit 66 UK schools (24 in Northern Ireland; 14 in each of England, Scotland and Wales), including approximately 7900 pupils. A questionnaire will be administered at baseline and at 12-14 months postintervention. The primary outcome is reported unprotected sex, a surrogate measure associated with unintended teenage pregnancy. Secondary outcomes include knowledge, attitudes, skills and intentions relating to avoiding teenage pregnancy in addition to frequency of engagement in sexual intercourse, contraception use and diagnosis of sexually transmitted infections.

ETHICS AND DISSEMINATION

Ethical approval was obtained from Queen's University Belfast. Results will be published in peer-reviewed journals and disseminated to stakeholders. Funding is from the National Institute for Health Research.

TRIAL REGISTRATION NUMBER

ISRCTN99459996.

Sexual and Reproductive Health Care Receipt Among Young Males Aged 15-24

PURPOSE

This study aimed to describe young men's sexual and reproductive health care (SRHC) receipt by sexual behavior and factors associated with greater SRHC receipt.

METHODS

There were 427 male patients aged 15-24 who were recruited from 3 primary care and 2 sexually transmitted disease (STD) clinics in 1 urban city. Immediately after the visit, the survey assessed receipt of 18 recommended SRHC services across four domains: screening history (sexual health, STD/HIV test, family planning); laboratories (STDs/HIV); condom products (condoms/lubrication); and counseling (STD/HIV risk reduction, family planning, condoms); in addition, demographic, sexual behavior, and visit characteristics were examined. Multivariable Poisson regressions examined factors associated with each SRHC subdomain adjusting for participant clustering within clinics.

RESULTS

Of the participants, 90% were non-Hispanic black, 61% were aged 20-24, 90% were sexually active, 71% had female partners (FPs), and 20% had male or male and female partners (M/MFPs). Among sexually active males, 1 in 10 received all services. Half or more were asked about sexual health and STD/HIV tests, tested for STDs/HIV, and were counseled on STD/HIV risk reduction and correct condom use. Fewer were asked about family planning (23%), were provided condom products (32%), and were counseled about family planning (35%). Overall and for each subdomain, never sexually active males reported fewer services than sexually active males. Factors consistently associated with greater SRHC receipt across subdomains included having M/MFPs versus FPs, routine versus non-STD-acute visit, time alone with provider without parent, and seen at STD versus primary care clinic. Males having FPs versus M/MFPs reported greater family planning counseling.

CONCLUSIONS

Findings have implications for improving young men's SRHC delivery beyond the narrow scope of STD/HIV care.

Structural Intervention With School Nurses Increases Receipt of Sexual Health Care Among Male High School Students

PURPOSE

Adolescent males are less likely to receive health care and have lower levels of sexual and reproductive health (SRH) knowledge than adolescent females. The purpose of this study was to determine if a school-based structural intervention focused on school nurses increases receipt of condoms and SRH information among male students.

METHODS

Interventions to improve student access to sexual and reproductive health care were implemented in six urban high schools with a matched set of comparison schools. Interventions included working with school nurses to improve access to sexual and reproductive health care, including the provision of condoms and information about pregnancy and sexually transmitted disease prevention and services. Intervention effects were assessed through five cross-sectional yearly surveys, and analyses include data from 13,740 male students.

RESULTS

Nurses in intervention schools changed their interactions with male students who visited them for services, such that, among those who reported they went to the school nurse for any reason in the previous year, those in intervention schools reported significant increases in receipt of sexual health services over the course of the study compared with students in comparison schools. Further, these results translated into population-level effects. Among all male students surveyed, those in intervention schools were more likely than those in comparison schools to report increases in receipt of sexual health services from school nurses.

CONCLUSIONS

With a minimal investment of resources, school nurses can become important sources of SRH information and condoms for male high school students.

Increasing boys’ and girls’ intentions to avoid teenage pregnancy: a cluster randomised controlled feasibility trial of an interactive video drama-based intervention in post-primary schools in Northern Ireland

Background

Adolescent men have a vital yet neglected role in reducing unintended teenage pregnancy (UTP). There is a need for gender-sensitive educational interventions.

Objectives

To determine the value and feasibility of conducting an effectiveness trial of theIf I Were JackRelationship and Sexuality Education (RSE) intervention in a convenience quota sample of post-primary schools in Northern Ireland. Secondary objectives were to assess acceptability to schools, pupils (male/female, aged 14–15 years) and parents/guardians; to identify optimal delivery structures and systems; to establish participation rates and reach, including equality of engagement of different socioeconomic and religious types; to assess trial recruitment and retention rates; to assess variation in normal RSE practice; to refine survey instruments; to assess differences in outcomes for male and female pupils; to identify potential effect sizes that might be detected in an effectiveness trial and estimate appropriate sample size for that trial; and to identify costs of delivery and pilot methods for assessing cost-effectiveness.

Design

Cluster randomised Phase II feasibility trial with an embedded process and economic evaluation.

Intervention

A teacher-delivered classroom-based RSE resource – an interactive video drama (IVD) with classroom materials, teacher training and an information session for parents – to immerse young people in a hypothetical scenario of Jack, a teenager whose girlfriend is unintentionally pregnant. It addresses gender inequalities in RSE by focusing on young men and is designed to increase intentions to avoid UTP by encouraging young people to delay sexual intercourse and to use contraception consistently in sexual relationships.

Main outcome measures

Abstinence from sexual intercourse (delaying initiation of sex or returning to abstinence) or avoidance of unprotected sexual intercourse (consistent correct use of contraception). Secondary outcomes included Knowledge, Attitudes, Skills and Intentions.

Results

The intervention proved acceptable to schools, pupils and parents, as evidenced through positive process evaluation. One minor refinement to the parental component was required, namely the replacement of the teacher-led face-to-face information session for parents by online videos designed to deliver the intervention to parents/guardians into their home. School recruitment was successful (target 25%, achieved 38%). No school dropped out. Pupil retention was successful (target 85%, achieved 93%). The between-group difference in incidence of unprotected sex of 1.3% (95% confidence interval 0.55% to 2.2%) by 9 months demonstrated an effect size consistent with those reported to have had meaningful impact on UTP rates (resulting in an achievable sample size of 66 schools at Phase III). Survey instruments showed high acceptability and reliability of measures (Cronbach’s alpha: 0.5–0.7). Economic evaluation at Phase III is feasible because it was possible to (1) identify costs of deliveringIf I Were Jack(mean cost per pupil, including training of teachers, was calculated as £13.66); and (2) develop a framework for assessing cost-effectiveness.

Conclusion

Trial methods were appropriate, and recruitment and retention of schools and pupils was satisfactory, successfully demonstrating all criteria for progression to a main trial. The perceived value of culture- and gender-sensitive public health interventions has been highlighted.

Future work

Progression to a Phase III effectiveness trial.

Trial registration

Current Controlled Trials ISRCTN99459996.

Funding

This project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 1. See the NIHR Journals Library website for further project information.

Parenting Among Adolescents and Young Adults with Human Immunodeficiency Virus Infection in the United States: Challenges, Unmet Needs, and Opportunities

Given the realistic expectations of HIV-infected adolescents and young adults (AYA) to have children and start families, steps must be taken to ensure that youth are prepared to deal with the challenges associated with their HIV and parenting. Literature reviews were conducted to identify published research and practice guidelines addressing parenting or becoming parents among HIV-infected AYA in the United States. Research articles or practice guidelines on this topic were not identified. Given the paucity of information available on this topic, this article provides a framework for the development of appropriate interventions and guidelines for use in clinical and community-based settings. First, the social, economic, and sexual and reproductive health challenges facing HIV-infected AYA in the United States are summarized. Next, family planning considerations, including age-appropriate disclosure of HIV status to those who are perinatally infected, and contraceptive and preconception counseling are described. The impact of early childbearing on young parents is discussed and considerations are outlined during the preconception, antenatal, and postnatal periods with regard to antiretroviral medications and clinical care guidelines. The importance of transitioning AYA from pediatric or adolescent to adult-centered medical care is highlighted. Finally, a comprehensive approach is suggested that addresses not only medical needs but also emphasizes ways to mitigate the impact of social and economic factors on the health and well-being of these young parents and their children.

Developing Federal Clinical Care Recommendations for Men

U.S. men experience substantial sexual and reproductive health needs across the life span. A significant barrier for providers in serving men in family planning, primary care, and sexually transmitted disease clinics has been the lack of standards for men's sexual and reproductive health care. The goal of this synthesis paper is to describe the development of clinical recommendations for the delivery of family planning services for men that were developed and published by CDC and the U.S. Office of Population Affairs. This paper is intended to describe the process used from 2011 to 2014 to develop the recommendations for the delivery of comprehensive reproductive healthcare services to men, and the rationale underpinning them.

Sexual and reproductive health care: adolescent and adult men's willingness to talk and preferred approach

INTRODUCTION

Sexually active adolescent and adult men have substantial sexual and reproductive health (SRH) needs, but little is known about their willingness and preferred approach to talk about SRH with their healthcare provider.

PURPOSE

To examine participants' willingness to talk about 11 SRH topics, including sexually transmitted disease (STD) risk; human papilloma virus (HPV) vaccine; condom use; female birth control methods; emergency contraception; concerns about sexual performance or making someone pregnant; being a father; relationships; testicular cancer; and acne, with their healthcare provider and their preferred approach (provider- or self-initiated).

METHODS

This cross-sectional clinic-based survey of 346 men aged 16-35 years was conducted in 2011. Bivariate analyses conducted in 2012 examined variation in study outcomes by participants' predisposing (age, race/ethnicity); enabling (education, past provider SRH discussion); and need factors (SRH concern).

RESULTS

Almost all participants (84%-98%) were willing to talk about all SRH topics. The top three topics included STD risk (98%); testicular cancer (98%); and HPV vaccine (97%). Among those willing to talk, the majority preferred their provider initiate the discussion (52%-88%). Participants reporting past provider discussions were more likely to prefer that their provider initiate discussions on condom use, female birth control methods, concerns about sexual performance and making someone pregnant, and relationships. Study outcomes did not vary by any other participant predisposing, enabling, or need factors.

CONCLUSIONS

These findings indicate that adolescent and adult men are willing to discuss a wide range of SRH topics with their healthcare provider. Providers need to move beyond whether male patients want to talk about these topics and instead proactively promote these conversations.

Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high-sexually transmitted infection prevalence communities

PURPOSE

Abstinence is a core pregnancy and sexually transmitted infection (STI) prevention strategy. We explore the attitudinal, behavioral, and family contexts relating to abstinence and the decision to delay sex among adolescent boys.

METHODS

Adolescent boys ages 14-17 years were recruited from community sites using a venue-based sampling method. All eligible boys at venues were invited to participate in an electronic survey. Question items included sexual behaviors, attitudes related to sex, relationships, masculine values, and family contextual items.

RESULTS

We enrolled 667 participants, mean age 15.7 years, of diverse ethnicity. A total of 252 were abstinent (38%). Abstinent participants were younger and less likely to report non-coital behaviors, and reported lower conventional masculine values. Among abstinent participants, 62% planned to delay sex, whereas 38% anticipated sex in the next year. Participants with lower conventional masculine values and more religious or moral motivations for abstinence were more likely to plan to delay sex.

CONCLUSIONS

Abstinence among boys is common, even in high-STI risk communities. For these boys, abstinence appears to be a complex behavioral decision influenced by demographic, behavioral, attitudinal, and contextual factors such as age, race, non-coital sexual behaviors, and masculine values. Understanding the attitudes and contexts of abstinence, including plans to delay sex, can inform the development of public health programs for early fatherhood and STI prevention.

Creating comprehensive, youth centered, culturally appropriate sex education: What do young gay, bisexual and questioning men want?

We examined young gay, bisexual and questioning men's (YGBQM) experiences with school-based sex education as they sought to learn about sex and sexual health, and their suggestions for improving same-sex education resources. Thematic analysis of 30 in-depth interviews with YGBQM (ages 18-24) underscored the discrepancies between the existing school-based sex education curricula and YGBQM's perceived sex education needs. Our results show that many youths' sexuality and same-sex sexual behaviors are excluded in sex education lessons; however, YGBQM noted that they sought out other resources (e.g., websites) to answer their questions. We discuss YGBQM's ideas for the creation of a sex and sexual health website that would be tailored for youth like themselves, including topics and features that an ideal website would contain. In addition, we present recommended changes to existing school-based sexual education curricula.

Effectiveness of a brief curriculum to promote condom and health care use among out-of-school young adult males

CONTEXT

Out-of-school black males aged 15-24 have higher levels of sexual risk-taking than in-school black males of the same age. However, few sexual risk reduction curricula are focused on out-of-school male youth.

METHODS

A sexual and reproductive health intervention conducted at a Baltimore youth employment and training program in 2008-2010 was evaluated in a study involving 197 youth aged 16-24 from a predominantly black population. Ninety-eight participants received three one-hour curriculum sessions on consecutive days; 99 served as controls. At baseline and three months later, participants completed a survey assessing demographic characteristics and various knowledge, attitude and behavior measures. Regression analysis with random effects was used to assess differences between intervention participants and controls in changes in outcomes over time.

RESULTS

In analyses adjusting for baseline characteristics, intervention participants showed greater improvements in outcomes between baseline and follow-up than did controls. Specifically, a male who received the intervention was more likely than a control male to report increases in knowledge of STDs and health care use (odds ratio, 1.6 for each), frequency of condom use (1.8), use of lubricant with condoms (23.6), communication with a provider about STDs (12.3) and STD testing (16.6).

CONCLUSION

These findings suggest the potential benefits of integrating safer-sex and health care information into a sexual and reproductive health curriculum for out-of-school male youth.

The "knucklehead" approach and what matters in terms of health for formerly incarcerated Latino men

In terms of the examination of the relationship between masculinity and health, there has been limited exploration of how the ways in which formerly incarcerated Latino men (FILM) construct their masculinities may conflict with public health messages. Using information gained from three years of ethnographic research that was conducted with formerly incarcerated Puerto Rican males in three urban communities in New York City, the authors examine what matters to FILM in terms of their health and well-being and what conflicts exist between public health prevention messages and FILM masculinity. Our results indicate the following: (1) major threats to the health of FILM, such as HIV risk behavior, alcohol and drug use and high caloric intake, are perceived as irrelevant to most of the FILM in the study; (2) young FILM believe that they engage in risky behaviors because of their "knucklehead" mentality and diminish their risks by becoming "street-smart;" and (3) social isolation, loneliness and general risk-taking behavior among FILM are salient issues that have yet to be effectively addressed. Of our sample of 32 FILM, we identified 7 individuals who have transitioned from having a "knucklehead" approach in their lives to possessing a greater sense of awareness of health and social matters. These seven individuals followed either or both of the following pathways: (1) pursuing a college education or (2) becoming community leaders.

Male adolescent sexual and reproductive health care

Male adolescents' sexual and reproductive health needs often go unmet in the primary care setting. This report discusses specific issues related to male adolescents' sexual and reproductive health care in the context of primary care, including pubertal and sexual development, sexual behavior, consequences of sexual behavior, and methods of preventing sexually transmitted infections (including HIV) and pregnancy. Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, performing an appropriate examination, providing patient-centered and age-appropriate anticipatory guidance, and delivering appropriate vaccinations. Pediatricians should provide these services to male adolescent patients in a confidential and culturally appropriate manner, promote healthy sexual relationships and responsibility, and involve parents in age-appropriate discussions about sexual health with their sons.

Neighborhood-level influences on young men's sexual and reproductive health behaviors

We used data from the 2002 National Survey of Family Growth to examine the influence of neighborhood characteristics on young males' sexual and reproductive health (SRH). We linked census-tract data to construct a Neighborhood Disadvantage Scale for 1092 never-married males aged 15 to 19 years, and we examined the association of neighborhood disadvantage with 11 SRH behaviors for each male. We found significant associations between neighborhood disadvantage and measures of partnering and pregnancy. Public health research and policies must consider the role of neighborhood context when addressing health behaviors.

Exploring Women’s Perceptions About Their Role in Supporting Partners’ and Sons’ Reproductive Health Care

Women serve as important health information sources for young men. No previous study has explored women’s perceptions about this role related to young men’s sexual and reproductive health (SRH) care. Twenty African American women recruited from two clinics participated in three focus groups to explore perceptions to engage young men in SRH care. Themes were identified that may facilitate and/or hinder women to engage young men in SRH care: 1) communication/actions to provide support; 2) challenges in providing support; 3) traditional gender role perceptions and other access barriers; and 4) motivation, influence and control. Participants were interested and willing to support young men’s SRH including sharing information about clinics (95%), making appointments (90%), going to visits together (90%), and having joint appointments (67%). Findings provide a foundation for programs interested to engage women as health promotion agents to improve young men’s SRH care access. Future efforts should explore the generalizability of study findings.

Creating Teachable Moments: A Clinic-Based Intervention to Improve Young Men’s Sexual Health

A multicomponent health education intervention for men was integrated into initial visits at the Young Men’s Clinic in New York City. In all, 157 predominantly low-income, Latino and African American patients completed pre- and post-test surveys to assess their sexual and reproductive health knowledge, beliefs, attitudes, and behaviors. Paired t tests compared respondents’ scores on outcome variables at baseline and follow-up. Intervention participants significantly increased their knowledge (e.g., emergency contraception) and frequency of safer sexual behaviors (e.g., condom use) during the 3 months following their initial visit. The intervention was not as successful promoting positive beliefs about health care utilization or attitudes about condoms. Participants reported high levels of satisfaction with the intervention. This study provides evidence that it is feasible to effectively disseminate sexual health information to men at each step of a routine clinic visit, including down time in waiting rooms and individual encounters with health educators and medical providers.

Real men do...real men don't: Young Latino and African American men's discourses regarding sexual health care utilization

There is growing recognition that men as well as women need sexual health care (SHC) services. Despite this, male friendly sexual health services are not readily available in the United States, and men are underutilizing the services that are available. This situation needs to be rectified to improve sexual health outcomes for men and women. In this study we conducted 10 focus groups with young adult Latino and African American men to examine their perceptions of the factors influencing SHC utilization among the men they know, with an emphasis on how notions of what it means to be a man affects health care seeking. The findings both amplify and complicate the relationship between masculinity and SHC seeking. They suggest new directions for public health efforts to enhance men's SHC utilization.