Factors influencing CDC- recommended preventative behaviors through the COVID-19 pandemic in college students

Objective: To understand how student perceptions of physical health and generalized concern about infection influenced engagement in COVID-19 preventive behaviors. Participants: 418 full-time undergraduate and graduate students attending a public university in South Carolina, USA. Methods: A self-administered survey was distributed during the 2020-2021 academic year. The health belief model, structural equation modeling, and regression methods were used to evaluate associations between students' perceived physical health and the use of CDC-recommended mitigation strategies. Results: Our findings suggest that an individual's perception of their own physical health impacted engagement in preventive behaviors by influencing concerns about disease severity (p = 0.01) and susceptibility (p = 0.03). However, perceived physical health was not associated with perceived benefits (p = 0.21), barriers (p = 0.57), or self-efficacy (p = 0.62) of mitigation strategies. Conclusions: Intrapersonal factors may play a strong role in the way a student undertakes disease control and prevention.

Evaluating the WISE (Women in the South-East) Telehealth Network: A Model of Healthcare and Health Promotion at Rural Libraries

PURPOSE

The purpose of this study was to evaluate the effectiveness of the WISE (Women in the South-East) Telehealth Network.

DESIGN

A follow-up survey design was used to determine the impact of the program on access to healthcare.

SETTING

WISE provided preventive care to women and gender expansive people at local libraries and the Mobile Library in the rural South Carolina Lowcountry.

SUBJECTS

In 1 year (February 2021-2022), WISE reached 523 individuals with 151 agreeing to participate in the study. Most participants identified as white (66%) or Black (22%).

INTERVENTION

A Community Health Worker provided health education, connection to telehealth services, referrals, and connected individuals with community and social services.

MEASURES

The Telehealth Usability Questionnaire (TUQ), changes in knowledge, satisfaction with WISE, Acceptability of Intervention measure (AIM), and sociodemographic characteristics.

RESULTS

Participants with a high telehealth usability score were significantly more likely to be under the age of 35 (OR 4.60 [95% CI 1.21-17.52]), married (OR 10.00 [95% CI 2.19-45.64]), or white (OR 4.00 [95% CI 1.06-15.08]). The intervention earned a high acceptability score 4.46 (± .61)/5.0 by helping participants obtain necessary medical care and resources, as well as meeting their educational needs.

CONCLUSION

This study offers practical suggestions to expand the use of telehealth initiatives to improve health outcomes by engaging libraries in rural communities.

"A Victim of Our Own Success:" Testing Jenny's First Sleepover's Dark Satire to Improve Attitudes Toward Childhood Vaccination

The COVID-19 pandemic resulted in substantially lower uptake of childhood vaccinations in the U.S. As vaccination rates struggle to rebound, childhood vaccine hesitancy continues to grow. Addressing vaccine disinformation and increasing catch-up vaccination is an urgent public health priority. The purpose of this study was to evaluate the effectiveness of "Jenny's First Sleepover," a darkly humorous satirical book about childhood vaccinations, to influence attitudes of vaccine hesitant parents. This study implemented a randomized pretest - posttest experimental design using a web-based survey with one intervention and one control. "Jenny's First Sleepover" improved attitudes toward vaccination among vaccine hesitant parents. Negative emotions were an important mediator of attitudes toward vaccinations. Findings identify mechanisms that increase effectiveness of satirical approaches, including the presentation of novel information about serious vaccine-preventable diseases with a dark narrative twist. Health communicators may consider a darkly humorous satirical approach to improve attitudes toward childhood vaccination among vaccine hesitant parents.

Attitudes on breast feeding among persons with HIV who have given birth and their perceptions of coercion during counseling on safe infant feeding practices

Persons with HIV can receive mixed messages about the safety of breastfeeding. We sought to assess if they felt coerced to formula feed when counseled about practices to reduce HIV transmission. Persons with HIV who had given birth were eligible to complete a survey to describe their experiences with infant feeding counseling and if they felt coerced to formula feed. An Iowa Infant Feeding Attitude Scale (IIFAS) assessed attitudes towards breastfeeding. Qualitative analyses were performed on narrative responses. One hundred surveys were collected from sites in Georgia, North Carolina, Pennsylvania, and South Carolina. The mean IIFAS score (n, 85) was 47 (SD 9.2), suggesting relatively favorable attitudes toward breastfeeding. Thirteen persons reported feeling coerced to formula feed. When controlling for choosing to give any breast milk, persons with any college education were more likely to report feeling coerced (aOR 9.8 [95% CI 1.8-52.5]). Qualitative analyses revealed three themes: perceiving breastfeeding as unsafe, engaging in shared decision-making, and resisting advice to formula feed. Persons with HIV desire to be counseled about safe infant feeding practices and have their questions answered without judgement. We highlight experiences of persons with HIV that reflect a need for a nuanced approach to infant feeding counseling.

Condoms on Campus: Understanding College Students' Embarrassment, Self-Efficacy, and Beliefs About Distribution Programs

BACKGROUND

Condom distribution programs are a structural-level intervention implemented on college campuses to reduce sexually transmitted infections and unplanned pregnancies. Understanding students' beliefs about these programs and attitudes that can affect condom use is critical.

METHODS

Students at 6 different universities (n = 2809) completed items related to beliefs about campus condom distribution programs and their personal condom embarrassment and condom self-efficacy levels. Surveys were completed both in classroom and online. T Tests and analysis of variance were used to examine differences based on demographics. Logistic regression was used to examine predictors of condom use.

RESULTS

College students support the distribution of condoms on campus (97.4%) but express moderate levels of embarrassment in condom acquisition and possession (mean, 19.37). Lower rates of embarrassment were reported for condom negotiation (mean, 9.13) and actual condom use (mean, 8.48). Lower overall rates of embarrassment were reported by condom users, men and individuals in relationships compared with noncondom users, women, and single individuals. Heterosexual students were more embarrassed than bisexual students about acquiring condoms and negotiating condom use. Condom users, men, and individuals in relationships had higher rates of condom self-efficacy compared with nonusers, women, and single students. There were no differences in self-efficacy based on sexual orientation. Embarrassment about acquiring and actual use of condoms, condom self-efficacy and demographics were all significant predictors of condom use.

CONCLUSIONS

Campus condom distribution programs are supported by college students. Interventions to address embarrassment and increase condom self-efficacy need to be tailored to different students based on gender, experience with condoms, and relationship status.

"Do you want a period?" Launching and evaluating a brief contraceptive decision-making educational intervention

OBJECTIVE

Do you want a period? empowers people who menstruate to better understand their reproductive health and contraceptive choices through informed patient-centered contraceptive decision-making.

METHODS

Researchers partnered with the WISE (Women in the South-East) Telehealth Network to design, implement and evaluate the Do you want a period? brief educational intervention. Participants completed a longitudinal research study, including a web-based survey at baseline and a mobile-optimized text-based survey up to 6 weeks following baseline.

RESULTS

Do you want a period? was believable (93%, n = 79), informative (89%, n = 76), and helpful (85%, n = 72). Participants who reported that the intervention was helpful were significantly more likely to be satisfied with the usefulness of information provided (OR 5.61 [95% CI 1.65-19.12]), the overall quality of services (OR 3.39 [95% CI 1.04-11.08)], and obtaining necessary medical care (OR 2.40 [95% CI 1.08-5.33)]. At longitudinal follow-up, participants who received contraceptive services reported high acceptability of intervention (4.51 (±0.53) out of 5).

CONCLUSIONS

Do you want a period? envisions a new dialogue between women and clinicians, family, and friends. This brief educational intervention supports people who menstruate to determine if a safe and effective tailored contraceptive regimen is right for them.

An exploratory study of condom sabotage and sexual health risk indicators in college students

Condom sabotage is a form of sexual assault that violates bodily autonomy, increasing the risk of unintended pregnancy and sexually transmitted infections (STI). The current study explored associations between reports of condom sabotage and sexual risk indicators among college students. College students (N = 466) completed a web-based cross-sectional survey. Students who reported experiencing condom sabotage were significantly more likely to describe themselves as single in comparison to students who described themselves as partnered (p = .002). After adjusting for relationship status, condom sabotage was significantly associated with reporting having multiple sexual partners (adjusted OR [aOR], 2.27; 95% CI, 2.22-42.28; p = .003), and being treated in the past 12 months for an STI (adjusted OR [aOR], 1,84; 95% CI, 1.82-21.98; p = . 004). The manuscript offers practical recommendations to develop health communication campaigns and public health interventions to prevent sexual assault, including condom sabotage, among college students.

"I'm More Open to Talking About It": Women's Experiences With Sexual Abuse and Reproductive Health

Approximately one in three women experience sexual abuse, which can result in negative reproductive health consequences. A history of sexual abuse may negatively impact health care seeking and experience. The purposes of this article were to understand how women perceived their sexual abuse experiences and how these experiences integrated into their overall reproductive health, reproductive planning, and health care access. As part of a larger study about women's reproductive health, researchers analyzed 16 in-depth interviews with women aged 18 years and older (range = 18-78) living in South Carolina (May-November 2016). A constant comparative method of data analysis was completed to explore women's sexual abuse experiences as they related to reproductive health and health care experiences. HyperRESEARCH 3.7.3 assisted in data organization and management. Limited bodily agency impacted women's ability to engage in family planning, particularly when partners utilized sexual coercion to maintain desired relationships and attain desired family size, regardless of women's preferences. In addition, limited sexual violence and abuse discussion in health care contexts impacted women's autonomy in reproductive health decision-making despite participants' desire to engage in these discussions with providers. Participants expressed a desire for communication about their sexual abuse experiences; however, results indicated women had to navigate stigma within families and communities, which deterred disclosure and open discussion. Negative health outcomes and desire to discuss these experiences within the health care context highlighted a need for patient-provider communication about sexual abuse history as one aspect of gynecologic care. Findings from this study offer practical recommendations to guide communication about sexual abuse within reproductive health care experiences to empower women in their reproductive health choices. As these experiences may impact overall health and reproductive choices, provider-initiated conversations with adolescents and women may improve care and assist in prevention efforts, including the prevention of negative health outcomes.

HPV Vaccination Champions: Evaluating a Technology-Mediated Intervention for Parents

Human papillomavirus (HPV) vaccination prevents 6 HPV-related cancers in men and women. Yet, rates of HPV vaccination among adolescents in the United States lag behind other developed nations, revealing a significant public health issue. This feasibility study tested a collaborative online learning environment to cultivate HPV vaccination champions. A 3-month training program recruited parents to serve as proponents and social media influencers to identify solutions to overcome barriers to HPV vaccination. A mixed methods study design included a pretest survey, three online asynchronous focus groups, a posttest survey, as well as a longitudinal follow-up survey at 6 months. Participants included 22 parents who self-identified as female (95.4%) and white (90.9%). Overall, there was a statistically significant difference in knowledge of HPV and HPV vaccination between pretest and posttest (p = 0.0042). This technology-mediated intervention increased parents' confidence and motivated them to speak more freely about HPV vaccination in-person and online with others in their social networks. Participants identified prevalent misinformation about HPV vaccination and learned how to effectively craft messages to address concerns related to safety and side effects, gender, understanding of risk, and sexual activity. Objective measures and qualitative open-ended assessment showed high intervention engagement and treatment satisfaction. All participants (100%) indicated that they enjoyed participating in the intervention. The effectiveness of this feasibility study suggests that social media is an appropriate platform to empower parents to counter vaccine hesitancy and misinformation through HPV vaccination information that is simple and shareable in-person and online.

Correcting HPV Vaccination Misinformation Online: Evaluating the HPV Vaccination NOW Social Media Campaign

The human papillomavirus (HPV) vaccine provides protection from six HPV-related cancers. Approximately half of South Carolina adolescents have not completed the vaccination series, representing a missed opportunity to prevent cancer. The HPV Vaccination NOW: This is Our Moment social media campaign is an initiative of the South Carolina Cancer Alliance (SCCA) and Hollings Cancer Center at the Medical University of South Carolina (MUSC). This statewide social media campaign aimed to increase parental awareness of and build vaccine confidence around HPV vaccination in S.C. The ten-week campaign was strategically implemented between June and August 2019 to encourage HPV vaccination at back-to-school medical appointments. A process evaluation showed that the campaign resulted in over 370,000 total impressions, reached over 33,000 individuals, and culminated with over 1122 followers. There were over 2700 engagements on Facebook and Twitter. A qualitative content analysis indicated that pro-vaccine and anti-vaccine comments were dominated by personal stories. Comments promoting misinformation about the HPV vaccine were often countered through peer-to-peer dialogue. Findings suggest that creating opportunities for the target audience to engage with campaign messages effectively corrected misinformation.

You Have Options: Implementing and evaluating a contraceptive choice social marketing campaign

Background:

Up to two-thirds of pregnancies among young, unmarried women in the United States are unintended, despite increased access to highly effective contraceptive options.

Aim:

This study implemented and evaluated a social marketing campaign designed to increase access to a full range of contraceptive methods among women aged 18–24 years on a southeastern university campus.

Methods:

Researchers partnered with Choose Well and Student Health Services to design, implement, and evaluate You Have Options, a 10-week multi-media social marketing campaign. The campaign aimed to raise awareness, increase knowledge, and improve access to contraceptive options, including long-acting reversible contraception (LARC) methods among college women. A pretest-posttest web-based survey design measured campaign awareness and recognition, as well as attitudes, subjective norms, and behavior.

Results:

Participants demonstrated a significant increase in knowledge about intrauterine devices (IUDs) between pretest ( M = 2.66, SD = 1.30) and posttest ( M = 3.06; SD = 1.96); t(671) = −2.60, p < .01). Analysis revealed that frequent exposure to the campaign prompted participants to engage in discussions about LARC with friends ( p < .05). In addition, 20- to 24-year-olds who reported seeing the campaign messages were more likely to seek out information ( p < .01) and adopt a LARC method ( p = .001) than 18- or 19-year-olds who saw the campaign messages.

Conclusion:

Findings from the study offer practical recommendations for implementing social marketing campaigns aimed at increasing access to LARC and reducing unintended pregnancy.

"Nobody's Ever Told Me That:" Women's Experiences with Shared Decision-making when Accessing Contraception

Half of all pregnancies in the United States are unintended. Contraceptive methods are effective in reducing unintended pregnancy burden. The shared decision-making model serves as best practice when choosing among healthcare options, and may be appropriate when considering contraceptive options. This study examined women's experiences with shared decision-making in contraceptive use dynamics. Researchers analyzed 38 interviews with women of reproductive age (range: 19-50 years) living in South Carolina (May-November 2016). Researchers completed a constant comparative method of data analysis using HyperRESEARCH 3.7.3 to explore reproductive-aged women's contraceptive decision-making. Shared decision-making provided a conceptual framework for analysis. Gaps in contraceptive knowledge, especially method effectiveness, impacted participants' experiences with contraception. Although participants believed they had adequate information, findings suggest they may not be fully informed about existing contraceptive options. Participants wanted options; however, results indicated women may not be actively involved in choosing contraception. Nuanced beliefs about contraception demonstrated preferences for patient-provider communication within the broader context of reproductive health and individual lifestyle needs. Findings from this study offer theoretical and practical recommendations to guide shared decision-making during contraceptive consultations to empower women in making informed and lifestyle-appropriate contraceptive choices.

Evaluating a Technology-Mediated HPV Vaccination Awareness Intervention: A Controlled, Quasi-Experimental, Mixed Methods Study

College-aged women and men are an important catch-up population for human papillomavirus (HPV) vaccination interventions. Limited research has explored technology-mediated HPV vaccination awareness interventions aimed at college students. The purpose was to evaluate a novel, technology-mediated, social media-based intervention to promote HPV vaccination among college students. A controlled, quasi-experimental, mixed methods study examined the feasibility of a technology-based intervention among two undergraduate classes (n = 58) at a public university in the southeastern United States of America. Classes were randomized to receive one of two cancer prevention programs (i.e., HPV vaccination (intervention) or healthy weight (control)). Both programs contained eight technology-mediated sessions, including weekly emails and private Facebook group posts. Participants completed pre-/post-test surveys and submitted weekly qualitative reflections. Data were analyzed using descriptive statistics and thematic review for qualitative data. Knowledge improved among participants in the HPV vaccination intervention relative to those in the control condition. Participants (97%) interacted on Facebook by "liking" a post or comment or posting a comment. Participants demonstrated robust engagement and high treatment satisfaction. Results suggests that social media is an effective platform to reach college students with health promotion interventions and increase HPV vaccination awareness in this important catch-up population.

Preparing for A COVID-19 Vaccine: A Mixed Methods Study of Vaccine Hesitant Parents

This study investigated vaccine acceptance of putative COVID-19 vaccines among a national sample of vaccine hesitant parents. Vaccine hesitancy and politicization of vaccine development has led to a pronounced distrust of COVID-19 vaccines in the U.S. A total of 1,381 vaccine-hesitant parents participated in this study. Participants indicated a general unwillingness to vaccinate their children (M = 3.55, SD = 2.13) and themselves (M = 3.58, SD = 2.16) when a COVID-19 vaccine becomes available. More educated parents were more likely to plan to vaccinate themselves [F(5, 533) = 9.93, p < .05] and their children [F(5, 533) = 10.278, p < .05]. Understanding vaccine hesitant parents offers crucial insights as a COVID-19 vaccine becomes available for the general public and as we wait for a vaccine to be approved for pediatric use.

Correction: A characterization of personal care product use among undergraduate female college students in South Carolina, USA

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Moving Oral Contraceptives over the Counter: Theory-based Formative Research to Design Communication Strategy

The American College of Obstetricians and Gynecologists (ACOG) recommends that oral contraceptives (OC) should be available over the counter (OTC). This study explored women's attitudes toward OC OTC in rural South Carolina. In-depth, individual interviews were conducted with 52 women ages 18-44 years old. Data analysis was informed by a reproductive justice theoretical framework and included an inductive, constant-comparative approach using HyperRESEARCH 3.7.5. Participants self-identified as either Black (62%) or White (28%). Participants believed that OC OTC would prevent unintended pregnancy by improving anonymity, convenience, and access to contraception. Many participants faced barriers to receiving a prescription, including time, transportation, cost, stigma, embarrassment, and clinician refusal based on religious reasons. Participants believed OC OTC would improve women's control over their fertility and emphasized the importance of health insurance coverage for OC OTC. Some participants expressed concerns about the risk of side effects, contraindications, and the potential for abuse. Some participants believed women, especially adolescents, required physician guidance and an annual exam to use OC. Findings suggest that a lack of knowledge and misinformation about the risks of OC serve as a barrier among some women in rural areas. Widespread acceptance of OC OTC will require messaging strategies to dispel safety concerns about OC OTC and empower women.

"The Closer, the Better:" The Role of Telehealth in Increasing Contraceptive Access Among Women in Rural South Carolina

BACKGROUND

Rural populations face unique health disparities that prevent women from accessing reproductive health care services. Telehealth initiatives offer a health care delivery tool to increase access to contraception.

OBJECTIVE

To understand women's contraceptive needs and perceptions of accessing contraception through telehealth services.

METHODS

Researchers conducted 52 in-depth interviews with women ages 18-44 years living in five rural counties in South Carolina from May to July 2015. Researchers employed constant comparative data analysis using HyperRESEARCH 3.7.2.

RESULTS

Most participants identified as Black (62%) or White (28%). Findings suggest successful telehealth interventions should accommodate women's complex and nuanced community views, including benefits and barriers of telehealth, to improve access to contraceptive methods in rural locations. In addition, telehealth initiatives should frame contraception as contributing to women's overall health and well-being.

CONCLUSIONS FOR PRACTICE

Telehealth initiatives may address barriers to contraceptive access in rural locations. Findings from this study offer theoretical and practical opportunities to guide telehealth interventions that support and empower women's access to contraceptive methods in rural areas.

Determination of Metals in Foodstuffs by Atomic Absorption Spectrophotometry after Dry Ashing: NMKL Interlaboratory Study of Lead, Cadmium, Zinc, Copper, Iron, Chromium, and Nickel

An interlaboratory study of a method for determination of lead, cadmium, zinc, copper, iron, chromium, and nickel in foodstuffs by atomic absorption spectrophotometry (AAS) after dry ashing at 450°C was conducted in 16 laboratories. The study was preceded by a practice round of familiarization samples and another round in which solutions were distributed and the metals were determined directly by AAS. The study included 5 different foods (liver paste, apple sauce, minced fish, wheat bran, and milk powder) and 2 composite diets. A single analysis was carried out on each sample. Suitable sample combinations were used as split level combinations for determination of the repeatability standard deviation. The relative reproducibility standard deviation for each of the elements ranged as follows: lead, 74-18% at 0.025-0.28 mg/kg; cadmium, 80-11% (0.002-0.51 mg/kg); zinc, 12-7% (44- 72 mg/kg); copper, 47-10% (0.48-41 mg/kg); iron, 35-9% (2-228 mg/kg); chromium, 48-21 % (0.008- 0.22 mg/kg); nickel, 64-39% (0.025-0.39 mg/kg).

'It is our duty:' Understanding Parents' Perspectives on Reproductive and Sexual Health Education

South Carolina ranks 16^th in the USA for highest rates of teenage pregnancy. The South Carolina Comprehensive Health Education Act (CHEA) does not require medically accurate, unbiased, culturally appropriate materials, and varies greatly in compliance and implementation. This study aimed to better understand parents' perspectives in one county in South Carolina regarding reproductive and sexual health education. A total of 484 parents responded to a qualitative questionnaire, collectively representing 798 students. Researchers conducted a thematic analysis to organise data. Main themes identified include comprehensive reproductive and sexual health education as a duty; dispelling the myth of abstinence-only education; and the value of comprehensive reproductive and sexual health education. Parents described teaching reproductive sexual health education in public schools as a 'duty.' Furthermore, parents rejected the idea that abstinence-only education is effective and believed reproductive and sexual health education should be taught without the influence of religion. Parents valued inclusive reproductive and sexual health education, covering a robust set of topics. Findings from the study provide evidence for the need to update current reproductive and sexual health education materials and legislation to meet parental demands and reduce youth sexual and reproductive health disparities.

A characterization of personal care product use among undergraduate female college students in South Carolina, USA

Some chemicals used in personal care products (PCPs) are associated with endocrine disruption, developmental abnormalities, and reproductive impairment. Previous studies have evaluated product use among various populations; however, information on college women, a population with a unique lifestyle, is scarce. The proportion and frequency of product use were measured using a self-administered survey among 138 female undergraduates. Respondents were predominately Caucasian (80.4%, reflecting the college's student body), and represented all years of study (freshman: 24.6%; sophomore: 30.4%; junior: 18.8%; senior: 26.1%). All respondents reported use of at least two PCPs within 24 h prior to sampling (maximum = 17; median = 8; IQR = 6-11). Compared with studies of pregnant and postpartum women, adult men, and Latina adolescents, college women surveyed reported significantly higher use of deodorant, conditioner, perfume, liquid soap, hand/body lotion, sunscreen, nail polish, eyeshadow, and lip balm (Chi Square, p < 0.05). More study is needed to understand the magnitude and racial disparities of PCP chemical exposure, but given the potential effects on reproduction and fertility, our findings of abundant and frequent product use among these reproductive-aged women highlight opportunities for intervention and information on endocrine disrupting chemical (EDC)-free alternative products and behaviors.

The myth of menstruation: how menstrual regulation and suppression impact contraceptive choice

BACKGROUND

Women in the US have access to various hormonal contraceptive methods that can regulate menstruation. This study examined the attitudes and perceptions of reproductive-aged women toward contraceptive methods, including how menstrual regulation and suppression preferences influenced contraceptive choice.

METHODS

Data collection used a mixed-methods approach, including 6 focus groups (n = 61), individual interviews (n = 18), and a web-based survey (n = 547).

RESULTS

Participants described contraceptive method preferences that allowed monthly bleeding and daily control, expressing concerns about long-acting reversible contraception (LARC) because of decreased user involvement. Some participants noted LARC improved their menstrual control. Many participants felt menstruation was healthy, whereas suppression was abnormal and resulted in negative health outcomes. Though participants indicated LARC as beneficial (M = 4.99 ± 1.66), convenient (M = 5.43 ± 1.68), and healthy (M = 4.62 ± 1.69), they chose combined oral contraceptives due to convenience.

CONCLUSIONS

Findings suggest women need more information about menstrual regulation and suppression before selecting a contraceptive method, specifically in relation to LARC versus combined oral contraception. Framing menstrual suppression as healthy and natural may improve perceptions of long-term health consequences related to LARC. Providers should discuss menstrual suppression safety to ensure selection of contraceptive options aligning with women's preferences and needs.

Understanding women's postpartum sexual experiences

This study aimed to understand women's sexual health experiences, specifically knowledge, attitudes and norms related to sexual behaviour resumption during the postpartum period. Semi-structured, reproductive health-focused interviews (N = 70) were conducted among women aged 18 years or older (range: 19-78) residing in South Carolina. Findings demonstrated that women identified clinicians as most influential concerning when they should and could resume sexual activity. Some women noted returning to sex earlier than anticipated due to personal and partner desire and indicated achieving considerable sexual satisfaction during the postpartum period. However, other participants noted difficulties resuming sexual activity, including pain and exhaustion from caring for a new baby. Findings provide practical recommendations for health professionals to further develop tailored, timely health messaging related to safe and healthy postpartum sexual behaviours. We discuss recommendations for health professionals to bring further awareness to varied postpartum sexual experiences.

Using the theory of planned behavior and self-identity to explore women's decision-making and intention to switch from combined oral contraceptive pill (COC) to long-acting reversible contraceptive (LARC)

Background

\Most college women use the combined oral contraceptive pill (COC) despite more effective long-acting reversible contraceptive (LARC) methods (e.g., IUDs and implant) being available. Resistance to change methods may be impacted by how a woman identifies with being a COC-user.

Methods

Data were collected via 186 web-based surveys distributed to female students attending a university in the southeastern United States (Mean age = 20.0 ± 1.; range = 18–22). Structural equation modeling (SEM) determined TPB fit in understanding LARC intention.

Results

SEM results received acceptable fit (χ2 (670, N = 186) p < 0.01, Comparative Fit Index (CFI) of 0.84, and Normative Fit Index (NFI) of 0.75). A Root Mean Square Error of Approximation (RMSEA) of 0.09 was produced, with a 90% confidence interval of 0.08 to 0.09. Including self-identity in the model yielded similar fit, with χ2 (866, N = 186) p < 0.01, CFI of 0.83, and NFI of 0.73. Self-identity and attitude pathways were significant (p < 0.01) toward intention, extending the TPB model.

Conclusions

The TPB proved to be acceptable in understanding COC users’ intention to obtain LARC. Results provide direction for LARC messaging tailored toward COC users and self-identity.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0772-8) contains supplementary material, which is available to authorized users.

A reproductive justice approach to understanding women's experiences with HPV and cervical cancer prevention

Cervical cancer is a preventable disease. HPV infection has been linked to more than 90% of cervical cancers. A vaccine to prevent the acquisition of HPV has been available since 2006. The purpose of this study was to investigate women's perceptions of cervical cancer prevention, including HPV vaccination. A reproductive justice framework guided data collection and analysis. In 2016, researchers conducted 70 in-depth, semi-structured qualitative interviews with women aged 19-78 years in South Carolina. A purposive sampling approach was employed to maximize requisite variety based on social, economic, and environmental axes of inequality. Participants self-identified as white (53%), African American (33%), and Hispanic (9%). Data analysis included an inductive constant comparative method to identify patterns and themes across the interviews. Misinformation about the prevalence and risk of HPV and cervical cancer led to "othering" of women with HPV-related diagnoses based on the flawed assumption of not being at risk. Participants described a lack of knowledge about the effectiveness and safety of the HPV vaccine. Social norms influenced participants' perceptions of HPV vaccination and cervical cancer, including concerns about sexual activity and intergenerational communication. Participants' social construction of identity, including race/ethnicity, socioeconomic position, ability, age, gender, sexual orientation, and immigration status, impacted their perceptions of cervical cancer screening and the HPV vaccine. In particular, participants believed that the HPV vaccine was "only for girls" and identified gender norms that limited uptake. Participants described barriers to accessing health care and cervical cancer screening, including cost, health insurance, and life changes (e.g., pregnancy, relocating). Many participants experienced an abnormal Papanicolaou test and described follow-up care, including biopsies and treatment for cervical dysplasia. Findings from this study offer insight into women's identity and perceptions of cervical cancer prevention. Results provide practical recommendations to increase women's agency in the development of successful public health interventions.

"My mama told me it would happen": menarche and menstruation experiences across generations

The purpose of this study was to understand women's menarche and menstruation-related knowledge, attitudes, and behaviors across generations. Women ages 18 years and older (Mean = 49.13 ± 14.76 years; Range = 19-78 years) living in South Carolina were recruited to participate in semi-structured interviews during May-November 2016. A total of 70 interviews were conducted, which were audio-recorded and transcribed verbatim. Thematic analysis using open and axial coding techniques from grounded theory provided the framework for data interpretation. Women described vivid menarche memories; however, most women had not received proper education or preparation for what to expect prior to onset. Participants discussed their experiences with menstrual products, oral contraceptives, and medical procedures to suppress, manipulate, or manage menstruation. Findings provide practical recommendations for health professionals to develop further effective and timely messaging related to menarche and menstruation across the lifespan. Messaging should inform women about what to expect with menarche, menstruation management, and health-related impacts, as well as methods to reduce menses-related myths and stigmas.

It's Your Place: Development and Evaluation of an Evidence-Based Bystander Intervention Campaign

Preventing sexual assault on college campuses is a national priority. Bystander intervention offers a promising approach to change social norms and prevent sexual misconduct. This study presents the implementation and evaluation of a theory-based campaign to promote active bystander intervention. The theory of planned behavior (TPB) served as a conceptual framework throughout campaign development and evaluation. Formative research published elsewhere was used to develop campaign strategies, communication channels, and messages, including "It is your place to prevent sexual assault: You're not ruining a good time." The It's Your Place multi-media campaign fosters a culture of bystander intervention through peer-to-peer facilitation and training, as well as traditional and new media platforms. A cross-sectional post-test only web-based survey was designed to evaluate the campaign and test the TPB's ability to accurately predict intention to intervene. Survey data were collected from 1,505 currently enrolled students. The TPB model predicted intention to intervene. There was a significant effect of campaign exposure on attitude, subjective norms, and perceived behavioral intention. This theory-based communication campaign offers implications for promoting active bystander intervention and reducing sexual assault.

It's Not My Place: Formative Evaluation Research to Design a Bystander Intervention Campaign

Sexual misconduct remains a problem on college campuses despite years of documentation and research, and program development and implementation. The purpose of this study was to conduct systematic theory-based formative audience research to understand how college women and men make meaning of sexual assault and bystander intervention. A total of 69 men and women aged 18 to 24 years participated in eight gender-specific focus group discussions. A grounded theory approach was used to identify patterns and themes across the data. Themes emerging from the data included the following: (a) female participants' experiences of sexism and misogyny, (b) the myth that rape is falsely reported, (c) complex understandings of consent and entitlement, (d) the reluctance to stop someone from having a "good time," (e) the role of alcohol as a moderating factor in sexual misconduct and bystander intervention, and (f) preference for direct and impactful messaging. This study informs researchers and practitioners about college students' perceptions of, and experiences with, bystander intervention and sexual assault. Practitioners can use this information to develop effective mixed media, campus-wide social marketing campaigns.

"My Body. My Choice": A Qualitative Study of the Influence of Trust and Locus of Control on Postpartum Contraceptive Choice

Postpartum contraception helps reduce unintended pregnancy and space births to improve maternal and child health. This study explored women's perceptions of contraceptive choice during the postpartum period in the context of locus of control and trust in healthcare providers. Researchers conducted six focus groups with 47 women, ages 18-39, receiving postpartum care at an outpatient clinic. Techniques from grounded theory methodology provided an inductive approach to analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated a constant-comparative coding process to identify emergent themes. Participants expressed a preference for relationship-centered care, in which healthcare providers listened, individualized their approach to care through rapport-building, and engaged women in shared decision-making about contraceptive use through open communication, reciprocity, and mutual influence. Conflicting health messages served as barriers to uptake of effective contraception. While participants trusted their healthcare provider's advice, many women prioritized personal experience and autonomy in decisions about contraception. Providers can promote trust and relationship-centered care to optimize contraceptive uptake by listening, exploring patient beliefs and preferences about contraception and birth spacing, and tailoring their advice to individuals. Results suggest that antenatal contraceptive counseling should incorporate information about effectiveness, dispel misconceptions, and engage patients in shared decision-making.

College Freshmen Students' Perspectives on Weight Gain Prevention in the Digital Age: Web-Based Survey

BACKGROUND

College freshmen are highly vulnerable to experiencing weight gain, and this phenomenon is associated with an increased risk of chronic diseases and mortality in older adulthood. Technology offers an attractive and scalable way to deliver behavioral weight gain prevention interventions for this population. Weight gain prevention programs that harness the appeal and widespread reach of Web-based technologies (electronic health or eHealth) are increasingly being evaluated in college students. Yet, few of these interventions are informed by college students' perspectives on weight gain prevention and related lifestyle behaviors.

OBJECTIVE

The objective of this study was to assess college freshmen students' concern about weight gain and associated topics, as well as their interest in and delivery medium preferences for eHealth programs focused on these topics.

METHODS

Web-based surveys that addressed college freshmen students' (convenience sample of N=50) perspectives on weight gain prevention were administered at the beginning and end of the fall 2015 semester as part of a longitudinal investigation of health-related issues and experiences in first semester college freshmen. Data on weight gain prevention-related concerns and corresponding interest in eHealth programs targeting topics of potential concern, as well as preferred program delivery medium and current technology use were gathered and analyzed using descriptive statistics.

RESULTS

A considerable proportion of the freshmen sample expressed concern about weight gain (74%, 37/50) and both traditional (healthy diet: 86%, 43/50; physical activity: 64%, 32/50) and less frequently addressed (stress: 82%, 41/50; sleep: 74%, 37/50; anxiety and depression: 60%, 30/50) associated topics within the context of behavioral weight gain prevention. The proportion of students who reported interest in eHealth promotion programs targeting these topics was also generally high (ranging from 52% [26/50] for stress management to 70% [35/50] for eating a healthy diet and staying physically active). Email was the most frequently used electronic platform, with 96% (48/50) of students reporting current use of it. Email was also the most frequently cited preferred eHealth delivery platform, with 86% (43/50) of students selecting it. Facebook was preferred by the second greatest proportion of students (40%, 20/50).

CONCLUSIONS

Most college freshmen have concerns about an array of weight gain prevention topics and are generally open to the possibility of receiving eHealth interventions designed to address their concerns, preferably via email compared with popular social media platforms. These preliminary findings offer a foundation to build upon when it comes to future descriptive investigations focused on behavioral weight gain prevention among college freshmen in the digital age.

Castor oil as a natural alternative to labor induction: A retrospective descriptive study

AIM

To describe birthing outcomes among women who consumed castor oil cocktail as part of a freestanding birth center labor induction protocol.

METHODS

De-identified data from birth logs and electronic medical records were entered into SPSS Statistics 22.0 for analysis for all women who received the castor oil cocktail (n=323) to induce labor between January 2008 and May 2015 at a birth center in the United States. Descriptive statistics were analyzed for trends in safety and birthing outcomes.

RESULTS

Of the women who utilized the castor oil cocktail to stimulate labor, 293 (90.7%) birthed vaginally at the birth center or hospital. The incidence of maternal adverse effects (e.g., nausea, vomiting, extreme diarrhea) was less than 7%, and adverse effects of any kind were reported in less than 15% of births. An independent sample t-test revealed that parous women were more likely to birth vaginally at the birth center after using the castor oil cocktail than their nulliparous counterparts (p<.010), while gestational age (p=.26), woman's age (p=.23), and body mass index (p=.28) were not significantly associated.

CONCLUSIONS

Nearly 91% of women in the study who consumed the castor oil cocktail to induce labor were able to give birth vaginally with little to no maternal or fetal complications. Findings indicate further research is needed to compare the safety and effectiveness of natural labor induction methodologies, including castor oil, to commonly used labor induction techniques in a prospective study or clinical trial.

Integrating Pregnancy Ambivalence and Effectiveness in Contraceptive Choice

Approximately 70% of pregnancies among young unmarried women living in the United States are unintended. Unintended pregnancy results in negative health and economic outcomes for infants, children, women, and families. Further research into the decision-making process of contraceptive selection is needed to meet young women's contraceptive needs in the United States. Overall, 53 women ages 18-24 years completed in-depth qualitative interviews. Researchers used analytical techniques from grounded theory and HyperRESEARCH 3.5.2 qualitative data analysis software to identify emergent themes. Problematic integration theory provided a theoretical lens to identify young women's probabilistic and evaluative orientations toward contraception. Researchers identified two profound values at stake to participants regarding their contraceptive decisions: avoiding pregnancy in the present, and protecting future fertility. Participants resisted long-acting reversible contraception (LARC) methods (e.g., the intrauterine device and the implant) due to concerns about safety and fears about infertility. Participants experienced ambivalence toward the idea of pregnancy, which complicated contraceptive decisions, especially regarding long-term methods. Uncertainty led participants to rationalize their use of less effective methods and reduced information seeking. Findings from this study offer practical suggestions for practitioners and health communication campaign planners. Contraceptive access campaigns should focus on the effectiveness, safety, and convenience of LARC methods. Messages should help young women make contraceptive choices that better fit their needs in order to reduce unintended pregnancy.

Voices of the "99 Percent": The Role of Online Narrative to Improve Health Care

CONTEXT

Communal blogs facilitate online narratives by providing opportunities for individuals to co-construct meaning and to engage in discussion about lived health experiences.

OBJECTIVE

To examine the role of health as a connective narrative among individuals organizing collectively in an online community. The "We are the 99 percent" Tumblr blog emerged as a spontaneous community platform of the Occupy Wall Street movement in the US.

DESIGN

Researchers conducted a qualitative content analysis of a total of 2003 blog posts.

MAIN OUTCOME MEASURES

Data analysis included a process of data reduction, display, and conclusion drawing and verification.

RESULTS

Bloggers discussed medical crises and the role of injury and illness in maintaining financial solvency. The difficulty of obtaining health care and the lack of accessible quality care emerged as themes. In particular, unemployment and underemployment limited access to health insurance coverage. The bloggers expressed dissatisfaction with the health care system and the impact of financial status on health. These challenges were exacerbated for marginalized populations, such as women and veterans.

CONCLUSION

Findings offer implications for the value of online narrative to improve health care initiatives and to provide insight to integrated health care systems, including health care practitioners, nonprofit organizations, hospitals, and policy makers. Results suggest opportunities to address the health care gaps of marginalized populations and to develop public health policy.

A Technology-Mediated Behavioral Weight Gain Prevention Intervention for College Students: Controlled, Quasi-Experimental Study

BACKGROUND

Both men and women are vulnerable to weight gain during the college years, and this phenomenon is linked to an increased risk of several chronic diseases and mortality. Technology represents an attractive medium for the delivery of weight control interventions focused on college students, given its reach and appeal among this population. However, few technology-mediated weight gain prevention interventions have been evaluated for college students.

OBJECTIVE

This study examined a new technology-based, social media-facilitated weight gain prevention intervention for college students.

METHODS

Undergraduates (n =58) in two sections of a public university course were allocated to either a behavioral weight gain prevention intervention (Healthy Weight, HW; N=29) or a human papillomavirus (HPV) vaccination awareness intervention (control; N=29). All students were enrolled, regardless of initial body weight or expressed interest in weight management. The interventions delivered 8 lessons via electronic newsletters and Facebook postings over 9 weeks, which were designed to foster social support and introduce relevant educational content. The HW intervention targeted behavioral strategies to prevent weight gain and provided participants with a Wi-Fi-enabled scale and an electronic physical activity tracker to facilitate weight regulation. A repeated-measures analysis of variance was conducted to examine within- and between-group differences in measures of self-reported weight control practices and objectively measured weight. Use of each intervention medium and device was objectively tracked, and intervention satisfaction measures were obtained.

RESULTS

Students remained weight stable (HW: -0.48+1.9 kg; control: -0.45+1.4 kg), with no significant difference between groups over 9 weeks (P =.94). However, HW students reported a significantly greater increase in the number of appropriate weight control strategies than did controls (2.1+4.5 vs -1.1+3.4, respectively; P =.003) and there was no increase in inappropriate weight control behaviors (P =.11). More than 90% of students in the HW arm opened the electronic newsletters each week, and the average number of Facebook interactions (comments and likes) per student each week was 3.3+1.4. Each self-monitoring device was initialized by 90% of HW students. On average, they used their physical activity tracker for 23.7+15.2 days and their Wi-Fi scale for 14.1+13.1 days over the 9 weeks. HW students rated the intervention favorably.

CONCLUSIONS

The short-term effect of this technology-based weight gain prevention intervention for college students is promising and merits evaluation over a longer duration to determine whether engagement and behavioral improvements positively affect weight outcomes and can be maintained.

A qualitative analysis of long-acting reversible contraception

Increasing access to long-acting reversible contraception (LARC), including the intrauterine device and the implant is a public health and clinical imperative to reduce rates of unintended pregnancy. In 2012, the American College of Obstetricians and Gynecologists recommended these methods for all women, including adolescents. Little research explores why young women reject these safe, effective contraceptive methods. A total of 53 women aged 18-24 years completed in-depth interviews. Analytical techniques from the grounded theory approach were used to identify patterns and themes across the data. Participants initiated hormonal contraception for "the pill's" beneficial side effects and believed a myth of perfect use, which constructed a false choice of LARC methods. Barriers to LARC options included access, medical resistance, and cost. Participants described a sense of unease about methods perceived as "alien." These women underestimated the risks of oral contraceptive pills and overestimated the risks of long-acting reversible contraception, including infertility. The myth of perfect use emerged as participants wanted to be in control by taking "the pill" every day; however, many described imperfect adherence. Findings include strategies for public health professionals and health care providers to distribute satisfactory and effective contraception for young women. Effective health communication campaigns will emphasize the desirable side effects, safety and increased effectiveness of LARC methods.

A Qualitative Study of Young Women's Beliefs About Intrauterine Devices: Fear of Infertility

INTRODUCTION

Approximately 80% of college-aged women are at risk of unintended pregnancy. The American College of Obstetricians and Gynecologists recommends long-acting reversible contraceptive (LARC) methods, including intrauterine devices (IUDs), as first-line pregnancy prevention for adolescents and young women. Yet, less than 5% of 15- to 19-year-old women using a method of contraception use LARC. Limited research explores young women's concerns about IUDs.

METHODS

As part of a larger women's health research study, researchers conducted 53 in-depth interviews with women, aged 18 to 24 years enrolled in a midsized liberal arts college in the southeastern United States. Analytical techniques from the grounded theory approach were used to code line-by-line and identify themes emerging from these data.

RESULTS

Fear of causing harm or infertility through IUD use emerged as a significant barrier to uptake. Negative and often unfounded beliefs about IUDs led to silence and limited observability of IUDs in daily life and health care contexts. Identity as a fertile woman emerged as an antecedent factor to the compatibility of IUDs with participants' values and beliefs.

DISCUSSION

The link between fear of infertility and perceived identity was found to be a major factor in young women's contraceptive decision making. In order to increase uptake of IUDs, the beliefs of women must be addressed.

Perceptions and correlates of pubic hair removal and grooming among college-aged women: a mixed methods approach

Background Although much is known about behavioural indicators of pubic hair removal, current research lacks deeper cognitive reasoning and understanding through utilising quantitative and qualitative methodologies. The purpose of this study was to: (1) describe and understand pubic hair removal behaviours using a quantitative survey; and (2) examine the relationship between pubic hair removal, sexual behaviours and genital self-image using in-depth interviews. Methods: Data were collected from women aged 18–24 years living in the United States. Overall, 663 participants completed an online survey and 53 completed in-depth interviews. Questions asked related to pubic hair removal and sexual history. Results: Participants removed hair for hygiene, comfort and sensation purposes, which was a personal decision influenced by family, friends and the media. Race, pubic hair removal initiation age, genital image and sexual behaviours were significantly related to pubic hair removal. Conclusions: Data from this study prove that further education regarding safe pubic hair removal methods is needed, especially for those who initiate pubic hair removal and sexual behaviours concurrently.

"It Makes You Rethink Your Choice of the Pill": Theory-Based Formative Research to Design a Contraceptive Choice Campaign

Half of all pregnancies in the United States remain unplanned despite improved access to highly effective long-acting reversible contraception, including the intrauterine device and the implant. This study conducted theory-based formative research to develop a contraceptive choice campaign aimed at increasing long-acting reversible contraception uptake by women ages 18-44 years in Charleston, South Carolina, an urban area in the southeastern United States. Researchers developed and tested message concepts and designs. Six focus groups and 18 interviews were conducted among reproductive-age women (n = 79). Qualitative data analysis revealed messages and designs that resonated with these women. Emphasizing long-acting reversible contraception as the healthy option, highlighting long-acting reversible contraception effectiveness, including relatable and trustworthy characters, and using language of control emerged as themes. Women reported a preference for statistics illustrating effectiveness combined with empowering messages of control over contraceptive decision making. Findings from this study offer practical recommendations for developing contraceptive choice campaigns targeting long-acting reversible contraception use and further the goal of reducing unintended pregnancy among women.

Mothers "Google It Up:" Extending Communication Channel Behavior in Diffusion of Innovations Theory

This study employed qualitative methods, conducting 44 in-depth interviews with biological mothers of newborns to understand women's perceptions and use of new media, mass media, and interpersonal communication channels in relation to health issues. Findings contribute to theoretical and practical understandings of the role of communication channels in diffusion of innovations theory. In particular, this study provides a foundation for the use of qualitative research to advance applications of diffusion of innovations theory. Results suggest that participants resisted mass media portrayals of women's health. When faced with a health question, participants uniformly started with the Internet to "Google it up." Findings suggest new media comprise a new communication channel with new rules, serving the functions of both personal and impersonal influence. In particular, pregnancy and the postpartum period emerged as a time when campaign planners can access women in new ways online. As a result, campaign planners could benefit from introducing new ideas online and capitalizing on the strength of weak ties favored in new media. Results expand the innovativeness/needs paradox in diffusion of innovations theory by elaborating on the role of new media to reach underserved populations. These findings provide an opportunity to better understand patient information seeking through the lens of diffusion of innovations theory.

Fifty years on "the pill": a qualitative analysis of nondaily contraceptive options

BACKGROUND

Despite widespread use of "the pill," half of all pregnancies in the United States remain unplanned. Although nondaily contraceptive options offer a safe, effective alternative to oral contraception, these methods are not widely used.

STUDY DESIGN

A total of 18 women aged 18-23 years completed in-depth interviews. Data analysis included a grounded theory approach and constant-comparative method using open and axial coding to reduce the data and identify themes across the data.

RESULTS

Social norms, health uncertainty and limited knowledge emerged as barriers to use of nondaily contraceptive options. Participants understood birth control as "the pill," and nondaily options were perceived as new and untested. Participants reported a lack of knowledge about the differences between methods and the effectiveness of nondaily options.

CONCLUSIONS

These findings offer practical suggestions to health communication campaign planners and health care providers to increase uptake of nondaily contraceptive options to improve method satisfaction and reduce unplanned pregnancies among young women.