Exploring the Role of Sex and Sexual Experience in Predicting American Indian Adolescent Condom Use Intention Using Protection Motivation Theory

Assessing the association between safety perceptions and communication about sex and drugs among Black adolescents exposed to adversity

The present study examined the association between safety perceptions and communication with a trusted adult about sex and drugs among Black adolescents exposed to adverse childhood experiences (ACEs) and the role of gender as a potential moderator in this association. Data were drawn from a small, randomized control pilot test of an adapted evidence-based intervention conducted from 2022 to 2023 in Baltimore, Maryland. The sample included 57 Black adolescents who had been exposed to ACEs (Mage = 15.14 years, SD = 0.81l; 47.4% female, 52.6% male). Information about safety perceptions, health communication, health behaviors, and demographic characteristics was measured using an electronic survey at baseline. Group differences by gender emerged among ACEs and substance use behaviors. Safety perceptions were significantly associated with communication with a trusted adult, B = 0.31, SE = 0.24, p = .039. As youth felt more unsafe, their communication with a trusted adult about sex and drugs increased; this association did not differ by gender. Health communication was also associated with ACEs. Black adolescents living with a parent with mental health challenges reported increased communication, B = 0.60, SE = 0.20, p = .005, whereas youth experiencing homelessness had reduced health communication, B = -0.63, SE = 0.24, p = .012. A lack of perceived safety significantly impacts health communication; however, having trusted adults outside of the home, school, and neighborhood can serve as a protective factor in reducing substance use and sexual risk-taking among this population.

Effectiveness of a Comprehensive School-Based Sex Education Program for Young Adolescents in the Netherlands

Most sexual education programs traditionally focused on providing sexual information regarding the risks of sex. However, current studies on sexual behavior in youth show a need for truly comprehensive sex education approaches with a sex-positive focus on sexuality, that effectively improve sexual competence. Therefore, in the current study the effectiveness of "Love is…", a four lesson school-based program based on the Sexual Interactional Competence model and Attitude-Social-Influence-Self-Efficacy-model was studied. A cluster-randomized controlled trial on the effectiveness of "Love is…" was conducted in 2018-2020. The sample consisted of 1160 adolescents in grades 8 and 9 from nine schools in the Netherlands. The sample was 48% female, 34% Dutch/Caucasian, 41% none-religious and 50% higher educated. They were randomized at class level into a program group [n = 32 classes; 567 students (Mage = 13.74 (SD = 0.74))] and a control group [n = 31 classes; 593 students (Mage = 13.86 (SD = 0.73))]. Results showed that "Love is…" increased sexual knowledge, that adolescents in the program group showed less cyber victim blaming attitudes and increased in communications skills after the program. In conclusion, the current study shows that "Love is…" was effective not only on the knowledge level, but also regarding sexual attitudes and competences. However, due to the developmental process of sexuality, there is a necessity to continue lessons in following grades through booster sessions by reinforcing competences as communicating comfortably about sexuality.On 12 November 2019 the study design and hypotheses were registered in the Dutch Trial Registration, number NL8150. ( https://onderzoekmetmensen.nl/nl/trial/26676 ).

Parenting in 2 Worlds: Testing improved parent-adolescent communication about sexuality in Urban American Indian families

Urban American Indian (AI) adolescents are more likely than non-Natives to have early sexual debut, teen pregnancies, sexually transmitted infections, and inadequate sexual health information. A RCT in three Arizona cities, with 585 parents of urban AI adolescents, tested whether a culturally tailored parenting intervention for urban AI families, Parenting in 2 Worlds (P2W), increased parent-adolescent communication about sexuality, compared to an informational family health intervention that was not culturally tailored. P2W produced significantly larger increases on two measures: communication about general sexual health and about sexual decision-making. The desired effects of P2W on the first measure were stronger short-term for cross-gender dyads, while for the second measure, they were stronger long-term for both mothers and fathers of adolescent sons.

Implementation Fidelity and Theory-Informed Dose Effects of a Teen Pregnancy Prevention Program for Native American Youth

In 2019, Native youth had the highest rate of teen pregnancy of all racial/ethnic groups. "Respecting the Circle of Life" (RCL) is one of the first evidence-based teen pregnancy prevention programs for Native teens and there is interest in replicating the program across tribal communities. To inform replication, it is important to consider process data including quality, fidelity, and dosage as these may all moderate impact of the program. Participants were Native youth aged 11-19 and a trusted adult. This study includes participants randomized to the RCL program only (N = 266). Data sources include independent observations, facilitator self-assessments, attendance logs, and self-report assessments completed by enrolled youth at baseline and 3 months post assessment. Data was compiled and summed by cohort. Dosage was number of minutes participating in activities separated by theoretical constructs. Linear regression models were utilized to assess moderation of the effects of the intervention dosage on outcomes of interest. Eighteen facilitators delivered RCL. One hundred eighteen independent observations and 320 facilitator self-assessments were collected and entered. Findings indicate RCL was implemented with high fidelity and quality (4.40 to 4.82 out of a 5-point Likert scale; 96.6% of planned activities completed). Dosage was high with an average completion of 7 out of 9 lessons. There was no association between theoretical construct dosage and outcomes of interest. Overall, this study indicates RCL was delivered with high fidelity, quality, and dosage in this trial. This paper informs future replication of RCL and provides support for hiring paraprofessionals from the local community as facilitators, delivering the RCL to peer groups of the same age and sex, delivering the RCL with short duration and high frequency, and encouraging youth to attend all RCL lessons, but continue to serve youth who have missed one or more lessons.

Predicting Adolescent Intervention Non-responsiveness for Precision HIV Prevention Using Machine Learning

Interventions to teach protective behaviors may be differentially effective within an adolescent population. Identifying the characteristics of youth who are less likely to respond to an intervention can guide program modifications to improve its effectiveness. Using comprehensive longitudinal data on adolescent risk behaviors, perceptions, sensation-seeking, peer and family influence, and neighborhood risk factors from 2564 grade 10-12 students in The Bahamas, this study employs machine learning approaches (support vector machines, logistic regression, decision tree, and random forest) to identify important predictors of non-responsiveness for precision prevention. We used 80% of the data to train the models and the rest for model testing. Among different machine learning algorithms, the random forest model using longitudinal data and the Boruta feature selection approach predicted intervention non-responsiveness best, achieving sensitivity of 85.4%, specificity of 78.4% and AUROC of 0.93 on the training data, and sensitivity of 84.3%, specificity of 67.1%, and AUROC of 0.85 on the test data. Key predictors include self-efficacy, perceived response cost, parent monitoring, vulnerability, response efficacy, HIV/AIDS knowledge, communication about condom use, and severity of HIV/STI. Machine learning can yield powerful predictive models to identify adolescents who are unlikely to respond to an intervention. Such models can guide the development of alternative strategies that may be more effective with intervention non-responders.

Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use

Objective

The American Indian/Alaska Native (AI/AN) population in the U.S. is thriving in spite of settler colonialist efforts of erasure. AI/AN people, however, continue to experience persistent health disparities including a disproportionate burden of substance use and sexually transmitted diseases/infections (STDs/STIs), as well as a disproportionate lack of public health STD screening services and STD prevention interventions grounded in AI/AN social contexts, experiences, and epistemologies. The present study explored how stressors and protective factors based on the Indigenist Stress Coping framework predict STD screening outcomes among Native adults.

Methods

We analyzed baseline self-report data from 254 Native adults ages 18-55 years with recent binge substance use who were enrolled in an evaluation of "EMPWR," a two-session STD risk reduction program in a rural, reservation-based community in the U.S. Southwest. Logistic regression models with robust variance were used to estimate odds ratios of lifetime STD testing for the theoretical stressors and cultural buffers.

Results

A little over half the sample were males (52.5%, n = 136), with a mean age of 33.6 years (SD = 8.8). The majority (76.7%, n = 195) reported having ever been screened for STD in their life. Discrimination score were significantly associated with lifetime STD testing: The higher discrimination was associated with lower odds of STD testing in the fully adjusted model (aOR = 0.40, 95%CI: 0.18, 0.92). The effects of AI/AN-specific cultural buffer such as participation in traditional practices on STD testing outcomes was in the expected positive direction, even though the association was not statistically significant. Household size was significantly associated with STD screening: The higher the number of people lived together in the house, the higher the odds of STD testing in the fully adjusted model (aOR = 1.19, 95%CI: 1.04, 1.38).

Conclusion

Our findings suggest that STD prevention programs should take into consideration AI/AN-specific historical traumatic stressors such as lifetime discrimination encounters and how these interact to drive or discourage sexual health services at local clinics. In addition, larger household size may be a protective factor functioning as a form of social support, and the extended family's role should be taken into consideration. Future research should consider improvement in measurements of AI/AN enculturation constructs.

Motivation for protection in sexual relationship during the COVID-19 quarantine: analysis of the sociodemographic variables of the Iranian population

Background

Coronavirus is an infectious disease that has affected sexual life. Sexual activity has decreased for many people, and couples' physical contact has reduced. The present study aimed to determine the sexual relationship of Iranian people and related factors during the Corona home quarantine by focusing on all constructs of the protective motivation theory.

Methods

This cross-sectional online survey was conducted on Iranian people under in-home quarantine from July to December 2020 during the Covid-19 pandemic. Seven hundred sixteen people were selected by the convenience sampling method. The data was gathered by an ad-hoc tool consisting of demographic information and sexual relationship regarding protection motivation behavior in the Covid-19 pandemic. Participants should be able to complete the online questionnaire because the questionnaires were completed online. One-way ANOVA, independent T, and Pearson correlation tests were used to analyze the data in SPSS 16 software.

Results

Findings indicate the average age of the participants was 37.78 + 8.34 years. Most of them were women (%85.1), married (%91.3) and had a university education (%90.2). In addition, %42.5% of participants had Full-time jobs and %34.2 lived in Tehran. 49.9% obtained information about corona from TV. 63.3% of the participants and their spouses did not catch Covid-19. Employment status was the only variable that was significantly different from sexual relationships regarding protection motivation (p = 0.031). Perceived response efficiency with an average of 79.12 had the highest, and perceived self-efficacy with an average of 69.92 had the lowest mean score among the areas of sexual relationship. Among the protection motivation domains of sexual behavior that all had significant correlations, there was no significant correlation between perceived severity and perceived self-efficacy (p = 0.067).

Conclusion and implication

Perceived vulnerability is associated with employment status, place of residence, and age. Sexual relationships regarding protection motivations are only associated with employment status. Overall, participants in the present study reported high levels of perceived severity, perceived vulnerability, perceived response efficiency, and perceived costs Therefore, they reported a high level of motivation for protective and preventive behaviors in their sexual relationship. Our findings suggest that future interventions should focus on general cognition by developing appropriate knowledge about the severity and vulnerability of Covid-19 and sexual behaviors, improving perceived response efficiency, and self-efficacy of protective behavior through skills training.

Protection Motivation Theory and Rabies Protective Behaviors Among School Students in Chonburi Province, Thailand

Objectives

The aim of this study was to predict rabies protective behaviors (RPB) based on protection motivation theory (PMT) among fourth-grade students at schools in Chonburi Province, Thailand.

Methods

This cross-sectional study was conducted from December 2020 to February 2021. A multistage sampling technique was used for sample selection. The questionnaire was divided into socio-demographic data and questions related to PMT and RPB. Descriptive statistical analysis was conducted using the EpiData program and inferential statistics, and the results were tested using the partial least squares model with a significance level of less than 5%.

Results

In total, 287 subjects were included, of whom 62.4% were girls and 40.4% reported that YouTube was their favorite media platform. Most participants had good perceived vulnerability, response efficacy, and self efficacy levels related to rabies (43.9, 68.6, and 73.2%, respectively). However, 54.5% had only fair perceived severity levels related to rabies. Significant positive correlations were found between RPB and the PMT constructs related to rabies (β, 0.298; p<0.001), and the school variable (S4) was also a predictor of RPB (β, -0.228; p<0.001). Among the PMT constructs, self efficacy was the strongest predictor of RPB (β, 0.741; p<0.001).

Conclusions

PMT is a useful framework for predicting RPB. Future RPB or prevention/protection intervention studies based on PMT should focus on improving self efficacy and response efficacy, with a particular focus on teaching students not to intervene with fighting animals. The most influential PMT constructs can be used for designing tools and implementing and evaluating future educational interventions to prevent rabies in children.

Diné (Navajo) female perspectives on mother-daughter communication and cultural assets around the transition to womanhood: a cross-sectional survey

Background

The inclusion of protective factors (“assets”) are increasingly supported in developing culturally grounded interventions for American Indian (AI) populations. This study sought to explore AI women’s cultural assets, perspectives, and teachings to inform the development of a culturally grounded, intergenerational intervention to prevent substance abuse and teenage pregnancy among AI females.

Methods

Adult self-identified AI women (N = 201) who reside on the Navajo Nation completed a cross-sectional survey between May and October 2018. The 21-question survey explored health communication around the transition to womanhood, cultural assets, perceptions of mother–daughter reproductive health communication, and intervention health topics. Univariate descriptive analyses, chi squared, and fisher’s exact tests were conducted.

Results

Respondents ranged in age from 18 to 82 years, with a mean age of 44 ± 15.5 years. Women self-identified as mothers (95; 48%), aunts (59; 30%), older sisters (55; 28%), grandmothers (37; 19%), and/or all of the aforementioned (50; 25%). 66% (N = 95) of women admired their mother/grandmother most during puberty; 29% (N = 58) of women were 10–11 years old when someone first spoke to them about menarche; and 86% (N=172) felt their culture was a source of strength. 70% (N = 139) would have liked to learn more about reproductive health when they were a teenager; 67% (N = 134) felt Diné mothers are able to provide reproductive health education; 51% (N = 101) reported having a rite of passage event, with younger women desiring an event significantly more than older women. Responses also indicate a disruption of cultural practices due to government assimilation policies, as well as the support of male relatives during puberty.

Conclusions

Results informed intervention content and delivery, including target age group, expanded caregiver eligibility criteria, lesson delivery structure and format, and protective cultural teachings. Other implications include the development of a complementary fatherhood and/or family-based intervention to prevent Native girls’ substance use and teen pregnancy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01473-4.

Adolescent HIV-related behavioural prediction using machine learning: a foundation for precision HIV prevention

BACKGROUND

Precision prevention is increasingly important in HIV prevention research to move beyond universal interventions to those tailored for high-risk individuals. The current study was designed to develop machine learning algorithms for predicting adolescent HIV risk behaviours.

METHODS

Comprehensive longitudinal data on adolescent risk behaviours, perceptions, peer and family influence, and neighbourhood risk factors were collected from 2564 grade-10 students at baseline followed for 24 months over 2008-2012. Machine learning techniques [support vector machine (SVM) and random forests] were applied to innovatively leverage longitudinal data for robust HIV risk behaviour prediction. In this study, we focused on two adolescent risk behaviours: had ever had sex and had multiple sex partners. Twenty percent of the data were withheld for model testing.

RESULTS

The SVM model with cost-sensitive learning achieved the highest sensitivity, at 79.1%, specificity of 75.4% with AUC of 0.86 in predicting multiple sex partners on the training data (10-fold cross-validation), and sensitivity of 79.7%, specificity of 76.5% with AUC of 0.86 on the testing data. The random forest model obtained the best performance in predicting had ever had sex, yielding the sensitivity of 78.5%, specificity of 73.1% with AUC of 0.84 on the training data and sensitivity of 82.7%, specificity of 75.3% with AUC of 0.87 on the testing data.

CONCLUSION

Machine learning methods can be used to build effective prediction model(s) to identify adolescents who are likely to engage in HIV risk behaviours. This study builds a foundation for targeted intervention strategies and informs precision prevention efforts in school-setting.

Sexually Unexperienced Adolescents Benefit the Most From a Sexual Education Program for Adolescents: A Longitudinal Cluster Randomized Controlled Study

Using a longitudinal cluster-randomized controlled design, we examined whether the effects of Competencies for Adolescents with a Healthy Sexuality (COMPAS), an evidence-based sexual health promotion intervention, differ by adolescents' sexual experience. Participants were 699 students aged 14-16, 45.9% were sexually experienced, and assessed in the baseline, posttest, and 12- and 24-month follow-ups. All were recruited from 10 schools that were randomly assigned to the COMPAS program and waiting-list groups (WLG). Using an intent-to-treat analyses, longitudinal changes in psychosocial and behavioral outcomes were explored using generalized estimating equations. Compared to the WLG, COMPAS had a positive impact on six of the seven psychological and behavioral outcomes. Non-sexually experienced reported more favorable HIV-related attitudes, higher condom use intention, lower number of sexual partners, and higher condom use than those sexually experienced. Findings support the importance of implementing sex education actions before adolescents get involved in their first intimate relationships in order to achieve greater impact.

Structural equation modeling test of the pre-intentional phase of the health action process approach (HAPA) model on condom use intention among senior high school students in Tianjin, China

Based on the Theory of Health Action Process Approach (HAPA) Model, this study aimed to investigate factors associated with condom use intention in Chinese adolescents.In 2017, we conducted a cross-sectional study using stratified cluster, convenience sampling method to assess condom use intention among senior high school students in Tianjin, China. One thousand eighty two senior high school students were anonymously surveyed through self-administered questionnaires. Structural equation modelling was used to assess the pre-intentional phase of HAPA model.Among the participants, 41.5% (449/1082) were male, 54.1% (585/1082) were female, 4.4% (48/1082) were gender-deficient. The average age was 16.7 years. The final pre-intentional phase of HAPA model was acceptable (CFI = 0.95; GFI = 0.94; RMSEA = 0.06). Action self-efficacy (r = 0.60) had a strong direct effect on condom use intention.The pre-intentional phase of HAPA model is valid to assess condom use intention among Chinese senior high school students. The pre-intention phase of the HAPA model could be applied to guide AIDS health educations of students, and further research is needed to evaluate the effect.

Predictors of Responsiveness Among American Indian Adolescents to a Community-Based HIV-Risk Reduction Intervention Over 12 Months

This analysis explored predictors of responsiveness to the Respecting the Circle of Life (RCL) intervention, a sexual and reproductive health program for American Indian (AI) youth. Data were collected over 12-month follow-up with 267 AI youth aged 13-19. We used mixed effects regression models to examine: (1) whether trajectory patterns of HIV/AIDS knowledge, condom beliefs, condom use self-efficacy, condom use intention and partner negotiation skills differed by baseline levels categorized into low, medium, and high scorers, and (2) the characteristics of youth who made no improvement over the post-intervention period. Results indicate the RCL intervention had greater longitudinal impact among subgroups with low and medium initial scores. High initial scores in knowledge, beliefs, efficacy, intention and skills predicted unresponsiveness to the RCL intervention. Youth differences in age, gender and school truancy (skipping/suspension) did not predict responsiveness to RCL. Results have important prevention science implications: (1) AI youth at greater risk (i.e., those with low initial levels of knowledge, beliefs, self-efficacy, intention and skills) are likely to respond to RCL and should be the target of replication and dissemination efforts. (2) Responsiveness analyses can guide adaptation of RCL and other sexual and reproductive health programs for AI youth to improve efficacy among unresponsive subgroups (i.e., high initial scorers). (3) RCL is equally likely to impact AI youth across different ages, genders and school status, thus validating population-wide implementation strategies.

Perspectives of adolescents regarding the sexual and reproductive health self-care: a theory-based qualitative research

Objectives It is widely accepted that sexual and reproductive health in adolescents are among the health priorities in the world that affects health aspects and the formation of beliefs and socioeconomic development in the community. However, achieving goals related to sexual and reproductive health is not possible without awareness and participation of the adolescents. On the other hand, proper knowledge about such issues can prevent many problems in this regard. Methods This qualitative study was carried out for one month in schools of Alborz University of Medical Sciences using content analysis. Data were collected from semi-structured, individual and in-depth interviews with female students. In addition, data analysis was performed using guided qualitative content analysis (theory-based). Results Analysis of the data led to the extraction of 11 primary codes classified in six categories of protection motivation constructs (perceived sensitivity, perceived severity, response efficiency, response cost, self-efficacy, and internal rewards) and two additional categories (communications and social contexts). Conclusion All interviewees found themselves exposed to sexually transmitted diseases and emphasized sexual self-care even though the majority of these individuals had inadequate self-efficacy.

Conversation, Condoms, and Contraception: How Does Communication With Sexual Partners Affect Safer Sexual Behaviors Among American Indian Youth?

Communication with sexual partners about protection against sexually transmitted infections (STIs) is associated with safer sexual behaviors among general populations of youth, but little is known about partner communication among American Indian youth. We assessed the prevalence of adolescents’ communication with sexual partners about STI prevention and used multivariable logistic regression to examine associations between communication and safer sexual behaviors (condom use, reliable contraceptive use, and dual method use) among a statewide sample of in-school, American Indian youth in Minnesota in 2013 and 2016 ( n = 739). Half (49.5%) of sexually experienced American Indian youth reported talking about STI prevention at least once with every sexual partner. Communication was associated with all examined safer sexual behaviors among females and only with condom use among males. Study findings highlight the importance of school nurses, health educators, and other clinicians addressing partner communication when counseling adolescent patients.