Characteristics of Young People Reporting a Low Sexual Desire in Switzerland

This study explores the characteristics of young female and male adults (mean age 26.3 years) reporting a low sexual desire. A 2017 Swiss national survey was carried out among young adults. Participants were divided into two groups based on their level of sexual desire: Low and High. Overall, 17.2% of females and 5.7% of males reported a low sexual desire. At the multivariate level, compared to females in the High group, females in the Low group had higher odds of being dissatisfied with their social life and with their sexual life in the past 4 weeks, having no current relationship and having accepted several times sexual intercourse without really wanting. Compared to males in the High group, males in the Low group had higher odds of reporting a non-heterosexual attraction (trend), having no current relationship and having accepted several times sexual intercourse without really wanting. The prevailing idea that young people, particularly males, always have high levels of sexual desire may not be accurate and warrants further consideration. These results show that sexual desire encompasses social aspects and underscore importance of addressing how stereotypes and social norms may influence our sexuality.

Dataset for vaginal human papillomavirus infection among adolescent and early adult girls in Jos, Nigeria

OBJECTIVES

To assess risk factors for HPV infection, determine knowledge about HPV vaccines, assess willingness to receive the HPV vaccine among adolescent and early adult girls in Nigeria, we administered a structured questionnaire. We also collected samples to determine the prevalence and patterns of HPV infections.

DATA DESCRIPTION

The dataset contains the responses of 205 participants from 10 randomly selected public and private secondary schools in Jos, Nigeria. The data includes information on risk factors for HPV infections such as sexual behaviours, knowledge about HPV vaccine and willingness to receive the vaccine. This is valuable information that can be compared to data from studies in other environments or to determine changes in the pattern of risk factors and HPV prevalence in this population over time.

Sexual dilemma among elderly men living with HIV/AIDS: a cross-sectional survey of the sexual needs and behaviours among HIV-positive men aged ≥50 years

OBJECTIVES

This study aimed to explore the factors associated with the sexual needs and behaviours among elderly men living with HIV/AIDS in Chongqing, China.

STUDY DESIGN

The study used a cross-sectional design.

METHODS

Data were collected through face-to-face interviews using a structured questionnaire by convenience sampling from July to December 2021. The chi-squared test and logistic regression were conducted to identify factors associated with sexual needs and behaviours.

RESULTS

In total, 63.70% of participants (493/774) reported having sexual needs. Individuals aged 50-59 years (odds ratio [OR] = 7.257, 95% confidence interval [CI]: 4.620, 11.401) and those who were married or cohabiting (OR = 1.595, 95% CI: 1.133, 2.246) reported high sexual needs. Among those with sexual needs, 69.17% (341/493) reported having sex in the past year. In total, 11.37% (40/341) and 9.68% (33/341) reported having commercial and casual sex, respectively. Participants aged 60-69 years (OR = 2.175, 95% CI: 1.128, 4.193), those who were married or cohabiting (OR = 3.371, 95% CI: 2.192, 5.184) and individuals who were employed (OR = 2.301, 95% CI: 1.339, 3.954) had higher odds of engaging in sexual behaviour, while participants with an awareness of AIDS-related knowledge (OR = 0.504, 95% CI: 0.307, 0.829) and those who had ≥1 year of antiretroviral therapy (ART) (ART 1-2 years: OR = 0.374, 95% CI: 0.176, 0.795; ART ≥3 years: OR = 0.429, 95% CI: 0.218, 0.846) had a lower likelihood of engaging in sexual behaviour.

CONCLUSIONS

The sexual needs and behaviours of elderly men living with HIV/AIDS in Chongqing, China, remain at a high level. There was a discrepancy between sexual needs and behaviours among elderly men living with HIV/AIDS. Continuous dissemination of sexual health education and the promotion of condom use are necessary.

Beliefs and misconceptions about contraception and condom use among adolescents in south-east Nigeria

BACKGROUND

Misconceptions about the usefulness of condoms and other contraceptives still expose many unmarried adolescents to the risk of unwanted teenage pregnancies and sexually-transmitted infections (STIs). This study explored beliefs and misconceptions about condoms and other contraceptives among adolescents in Ebonyi state, south-east Nigeria.

METHOD

A qualitative study was undertaken in six local government areas in Ebonyi state, southeast Nigeria. Data were collected within a period of one month from in and out-of-school adolescents aged 13-18 years using twelve focus group discussions (FGD). The data were analyzed using the thematic framework approach.

RESULT

Majority of the adolescents were knowledgeable about methods of contraception, how they are used and their modes of action. They were also knowledgeable about the dual effects of condoms in prevention of pregnancy and STIs. However, some misconceptions that were expressed by some adolescents were that pregnancy could be prevented by the use of (i) hard drugs, (ii) laxatives, (iii) white chlorine, and (iv) boiled alcoholic beverages. Condoms were described by some adolescent boys as reusable. Condoms were also perceived by some adolescents to reduce sexual pleasure, and this opinion was mostly held by boys. Coitus interruptus (withdrawal method) was therefore considered more preferable than condoms for prevention of pregnancy.

CONCLUSION

Although majority adolescents have knowledge about contraception and condom use, some misconceptions still persist. These misconceptions put many adolescents at increased risk for pregnancy and STIs which are detrimental to their health and wellbeing. Concerted efforts should be made through educational and behaviour change interventions in schools and within communities to debunk persisting misconceptions about contraception including the use of condom, and properly educate adolescents on safe sex practices. Adolescents engage in unprotected sexual intercourse and other risky sexual behaviours because of some mistaken beliefs and wrong impressions about how to prevent unwanted pregnancy. These risky sexual behaviours predispose adolescents to sexually transmitted infections, unsafe abortion and other reproductive health problems. In this qualitative study, we explored some of these mistaken beliefs about condoms and other methods of preventing pregnancy. During focus group discussions, adolescents identified modern contraceptive methods, and described their modes of action and how they are used. They also discussed their contraceptive preferences and perceived effects of condoms on sexual pleasure. Although some of these adolescents were able to correctly mention various types of contraceptives and their modes of action, there were numerous wrong impressions. Hard drugs, laxatives, white chlorine and boiled alcoholic beverage were listed as emergency contraceptive methods. Emergency pills were perceived to work by flushing away spermatozoa from a girl's system after sexual intercourse. Male condoms were perceived to be potentially dangerous because they could break and enter into the body of the female sexual partner. Some adolescent boys had the notion that particular brands of male condoms could be washed and reused. Notions about condom use and sexual pleasure varied for girls and boys. Some adolescent girls perceived that condom use during sex increases sexual pleasure because of the assurance of being protected from STIs and pregnancy. Adolescent boys were of the opinion that condoms interfere with the pleasure of direct 'flesh to flesh' contact during sex. There was a general belief that contraceptive use in early age reduces fertility prospects for boys and girls. Mistaken beliefs about methods of preventing pregnancy persist among adolescents, and this raises concerns about the quality of information they receive. Concerted efforts should be made to debunk these wrong beliefs and properly educate adolescents on safe sex practices.

Contraceptives and sexual behaviours in predicting pregnancy rates in HIV prevention trials in South Africa: Past, present and future implications

OBJECTIVE

Despite all efforts, high pregnancy rates are often reported in HIV biomedical intervention trials conducted in African countries. We therefore aimed to develop a pregnancy risk scoring algorithm for targeted recruitment and screening strategies among a cohort of women in South Africa.

METHODS

The study population was ~ 10,000 women who enrolled in one of the six biomedical intervention trials conducted in KwaZulu Natal, South Africa. Cox regression models were used to create a pregnancy risk scoring algorithm which was internally validated using standard statistical measures.

RESULTS

Five factors were identified as significant predictors of pregnancy incidence:<25 years old, not using injectable contraceptives, parity (<3), being single/not cohabiting and having ≥ 2 sexual partners in the past three months. Women with total scores of 21-24, 25-35 and 36+ were classified as being at "moderate", "high", "severe" risk of pregnancy. Sensitivity of the development and validation models were reasonably high (sensitivity 76% and 74% respectively).

CONCLUSION

Our risk scoring algorithm can identify and alert researchers to women who need additional non-routine pregnancy assessment and counselling, with statistically acceptable accuracy and robustness.

The socioeconomic and lifestyle determinants of contraceptive use among Chinese college students: a cross-sectional study

BACKGROUND

Chinese youth have become more sexually active over the years, yet their behaviours of contraceptive use are influenced by socioeconomic and lifestyle factors. This study aimed to investigate the socioeconomic and lifestyle determinants of contraceptive use among Chinese college students, and to investigate quantitatively their reasons for choosing different contraceptive methods.

METHODS

The study used the data from a cross-sectional survey, which was conducted in 2015 among 17,517 students from 130 colleges and professional schools in mainland China. Chi-square tests were performed to test the differences in the awareness and uses of contraceptives between male and female students. Multivariable logistic regression models were used to analyse the associations between socioeconomic and lifestyle factors and contraceptive uses.

RESULTS

Condoms (95%), oral contraceptives (91%) and emergency contraceptives (71%) were the most commonly known contraceptive methods among the sample of Chinese youth that were surveyed. Among male participants, high monthly expenditure (OR = 1.37, 95%CI: 1.07-1.75), light alcohol consumption (OR = 1.47, 95%CI: 1.03-2.11), and high sexual knowledge (OR = 1.96, 95%CI: 1.57-2.45) were positively associated with contraceptive uses, while tobacco use (OR = 0.47, 95%CI: 0.23-0.95) showed a negative association with contraceptive uses. Among female students, suburban residency (OR = 1.38, 95%CI: 1.03-1.83), high level of parental education (OR = 1.96, 95%CI: 1.19-3.22), moderate alcohol consumption (OR = 2.66, 95%CI: 1.05-6.77), and high sexual knowledge (OR = 1.50, 95%CI: 1.18-1.91) were positively associated with contraceptive uses, while tobacco use (OR = 0.60, 95%CI: 0.36-0.99) showed a negative association.

CONCLUSIONS

A series of socioeconomic and lifestyle factors were associated with contraceptive choices among Chinese college students. Targeted sexual education programs are in demand to improve the awareness and the use of contraceptives in this population.

[The mediating role of attitudes between the sexual behaviours of men and women]

OBJECTIVE

The aim of this research was to verify the mediating effect of attitudes toward sexual behaviours in the relationship between sex and the number of sexual behaviours performed.

MATERIAL AND METHOD

A total of 763 Spanish people (42.2% men and 57.8% women) ranging in age from 18 to 65 years (M=25.60; SD=9.23) identified as heterosexual participated. At the time of the study, 56.9% had a steady partner, 10.1% had a casual partner and 33.0% did not have partner. In addition to sociodemographic questions, the Attitudes toward Sexual Behaviours Scale and a Checklist of Sexual Behaviours were administered online.

RESULTS

The results show that attitudes toward sexual behaviours correlate positively with the number of sexual behaviours performed (r=.481; P<.001) and that men have more positive attitudes toward sexual behaviours (t=10.273; P<.001; d=.75) and they engage in a greater number of sexual behaviours (t=6.412; P<.001; d=.47) than women. Finally, there is total mediation of attitudes toward sexual behaviours between sex and the number of sexual behaviours performed in the 3subsamples (steady partner, casual partner, without a partner).

CONCLUSIONS

Men engage in a greater number of different sexual behaviours than women because their attitudes toward sexual behaviours are more positive. Therefore, if we want to influence certain sexual behaviours, we should focus on the attitudes toward these behaviours.

High risk men who have sex with men in Spain are reporting low intentions of actively seeking HIV testing: results from a cross-sectional study

Background

We analyse unprotected anal intercourses (UAI) self-reported by a sample of men who have sex with men (MSM), by their future testing intentions and past testing history to identify undertested subpopulations that could be contributing to onward transmission.

Methods

We recruited MSM through gay dating websites in Spain from September 2012 to April 2013. For MSM at risk of acquiring or unknowingly transmitting HIV (at risk hereafter) we calculate time at risk, number of UAI in the last 12 months and last 5 years by testing intention (low intention (LI), Medium intention (MI), high intention (HI)) and past testing history. For never testers we analyse the reasons for not having been tested.

Results

Of 3272 MSM at risk, 19.8% reported LI of testing. MSM with LI reported the longest period at risk (8.49 years (p < 0.001)) and reported 3.20 UAI/person in the last 12 months (vs. 3.23 and 2.56 in MSM with HI and MI (p < 0.001)) and 12.90 UAI/person in the last 5 years (vs. 8.07 and 9.82 in MSM with HI and MI (p < 0.001)). Those with LI accounted for 21 and 27% of all the UA acts occurring in the last 12 months and the last 5 years. Among never testers (40.6%), those with LI reported lower risk perception (p = 0.006).

Conclusion

We identified a group of high risk and undertested MSM that could be behind a substantial proportion of the UAIs with potential of transmission/acquisition of HIV. Given their low willingness to seek an HIV test and low risk perception, they constitute a population that will probably require approaches other than client initiated strategies.

The condom use among young adults and its determinants: an Italian study

Numerous health risk behaviours have been identified as an issue in early adulthood, especially among university students, a particularly high-risk category for sexual and reproductive health. The aim of this study is to examine the condom use and its determinants among young adult in Italy. The hypothesis is that individuals' demographic characteristics (gender, faculty, to have a committed partner, to be resident) and the risk perception may play a role in condom use. The results indicate that the frequency of condom use is related to the magnitude of risk perception of certain STIs and to demographic characteristics. All the STI risks perception and the risk perception of unintended pregnancy are statistically significant associated with frequency of condom use (p<0.001). By contrast the frequency of condom use is not statistically significant associated with the following demographic characteristics: gender, faculty, to have a committed partner, to be resident. Furthermore association with age groups is observed (p=0.030). Findings suggest that universities have an opportunity to access young people's sexual health risk behaviours and at the same time to impact on sexual health promotion. University health educators and staff at student health centers could play an active role in educational campaigns.

HIV risk perception and sexual behaviors among female sex workers in Tehran, Iran

Background: An adequate perception of the degree to which one is at risk of having or contracting HIV is necessary for behavioural change and the adoption of safe behaviours. There are limited data regarding HIV risk perceptions among female sex workers in Iran. This study aimed to determine the HIV risk perception status and its association with sexual behaviours among female sex workers in Tehran. Methods: A cross sectional study was conducted among 170 female sex workers in Tehran. Participants were recruited using a combination of snowball, purposeful, and convenience sampling methods. Multiple logistic regression was used to identify adjusted associations between background factors, sexual behaviours, and HIV risk perception. The analysis was conducted by the "logistf" package in the R statistical system. P-value less than .05 was considered as statistically significant. Results: Among the participants, 122 (77%) reported high HIV risk perception. Most female sex workers with high HIV risk perception reported that they did not consistently use condoms (n=120, 98%. Female sex workers with a higher frequency of sex work (AOR=1.18, 95% CI: 1.08, 1.31), inconsistent condom use (AOR=0.15, 95% CI: 0.02, 0.66), a history of HIV testing (AOR=5.1, 95% CI: 1.2, 26.0), and low HIV knowledge (AOR=0.97, 95% CI=0.95, 0.996) were more likely to report high HIV risk perception. Conclusion: Most female sex workers with risky sexual behaviours had a high HIV risk perception. Effective educational programs are suggested to enable female sex workers to correctly assess their own HIV risk and change risk behaviors based on self-assessment of actual risk.

Effect of selenium supplementation on attainment of puberty in Saanen male goat kids

The aim of the study was to evaluate the effect on selenium supplementation on attainment of puberty in Saanen male goat kids. Forty Saanen male goats kids were divided into two groups: selenium supplemented (n = 20) and control (n = 20). The treatment group received sodium selenite at a ninety days interval for an experimental period of 150 days. All experimental Saanen male goat kids were fed Lucerne hay deficient in selenium. The development of the reproductive functions of the male goat kids was monitored until puberty. At the age of 5.5 months motile spermatozoa were collected from 65% of the supplemented group compared to 35% of the control. At 140 days following supplementation the treated group showed significantly higher semen volume per ejaculate and improved semen quality in the form of improved spermatozoa motility and concentration and a decreased percentage of dead spermatozoa, spermatozoa abnormalities and acrosome damage compared to the control. Supplementation with selenium significantly (P < 0.05) improved body weight, testicular measurements and decreased age at puberty. Selenium supplementation also led to higher (P < 0.05) LH and testosterone concentrations. It is concluded that selenium supplementation hastened age at attainment of puberty to 5.5 months in male Saanen kids as the control group attained puberty at 6 months. It also improved semen quality and reproductive hormones concentration of Saanen kids.

Sexual behaviours and sexually transmitted infection outcomes in a cohort of HIV-negative men who have sex with men attending sexual health clinics in England

Men who have sex with men (MSM) attending sexual health (SH) clinics are at high risk for HIV acquisition and are disproportionately affected by sexually transmitted infections (STIs). We collected standardised behavioural data from MSM attending clinics to characterise sexual behaviours and identify predictors for HIV and STIs. In 2012–2013, HIV-negative MSM attending five SH clinics in England reported sexual behaviours in the previous three months via a self-administered questionnaire. Behaviours were linked to the individual’s clinical records using national surveillance. The prevalence and incidence of bacterial STIs (gonorrhoea, Chlamydia, lymphogranuloma venereum and syphilis) and incidence of HIV were calculated. Adjusted odds ratios and hazard ratios with 95% confidence interval (CI) were reported for significant predictors. Of 1278 HIV-negative MSM, 54% were of white ethnicity and UK-born and 43% were 25–34 years old. Almost all men reported at least one partner in the last three months. Half reported condomless anal sex and 36% condomless receptive anal intercourse (CRAI). Incidence of bacterial STIs was 46/100 (95%CI 39–54) person years (py) and of HIV was 3.1/100 (95%CI 1.7–5.6) py. A STI at baseline and CRAI with increasing numbers of partners were associated with both incident infections. In this cohort of MSM high-risk behaviours and STIs were prevalent. Engagement in CRAI increased the likelihood of subsequent infection, while men diagnosed with a bacterial STI were at increased risk of a future STI. Clinical and behavioural risk assessments to determine an individual’s risk of infection could allow a more nuanced prevention approach that has greater success in reducing transmission.

STI-protective self-efficacy and binge drinking in a sample of university students in the United Kingdom

OBJECTIVE

Alcohol use has consistently been shown to be related to sexual risk-taking behaviours. To assess what factors may contribute to the sexual risk decision-making process, this study examined the relationships among alcohol use (frequency, quantity, and binge drinking), cognitive appraisals of sexual risk taking, sex-related alcohol expectancies, and STI-protective self-efficacy.

METHOD

138 sexually-active university students who drink alcohol completed scales measuring alcohol consumption, appraisals of consequences, sex-related alcohol expectancies, and items regarding STI-protective self-efficacy.

RESULTS

Increasing levels of binge drinking were negatively associated with STI-protective self-efficacy. A moderated mediation analysis revealed that for binge drinkers, stronger appraisals of the positive consequences for having sexual intercourse while intoxicated predicted lower STI-protective self-efficacy indirectly through increasing rates of sex-related alcohol risk expectancies.

CONCLUSION

Findings provide evidence of a need to target binge drinkers and increase their STI-protective self-efficacy by shifting their focus from positive consequences to negative risk consequences of engaging in sexual intercourse while intoxicated.

Early sexual experiences of teenage heterosexual males in Australia: a cross-sectional survey

OBJECTIVE

There are limited data on the patterns of early sexual behaviours among Australian teenage heterosexual boys. This study describes the nature and onset of early sexual experiences in this population through a cross-sectional survey.

DESIGN

A cross-sectional survey between 2014 and 2015 SETTING: Major sexual health clinics and community sources across Australia PARTICIPANTS: Heterosexual men aged 17-19 years RESULTS: There were 191 men in the study with a median age of 19.1 years. Median age at first oral sex was 16.4 years (IQR: 15.5-17.7) and 16.9 years (IQR: 16.0-18.0) for first vaginal sex. Most men had engaged in oral sex (89.5%) and vaginal sex (91.6%) in the previous 12 months with 32.6% reporting condom use at last vaginal sex. Of the total lifetime female partners for vaginal sex reported by men as a group (n=1187): 54.3% (n=645) were the same age as the man, 28.3% (n=336) were a year or more younger and 17.4% (n=206) were a year or more older. Prior anal sex with females was reported by 22% with 47% reporting condom use at last anal sex. Median age at first anal sex was 18.2 years (IQR: 17.3-18.8). Anal sex with a female was associated with having five or more lifetime female sexual partners for oral and vaginal sex.

CONCLUSIONS

These data provide insights into the trajectory of sexual behaviours experienced by teenage heterosexual boys following sexual debut, findings which can inform programme promoting sexual health among teenage boys.

Saliva use in sex: Associations with use of smartphone dating applications in men who have sex with men

Smartphone dating applications have become a primary source for men who have sex with men (MSM) to meet sexual partners. It has been found that MSM who used smartphone dating applications are at higher risk of gonorrhoea, but the reasons remain unknown. This study aimed to investigate whether MSM who met their partners via smartphone dating applications are more likely to engage in sexual practices such as rimming (oro-anal sex), and use of partner's saliva as a lubricant, that are associated with the risk of gonorrhoea. A cross-sectional study was conducted among 1672 MSM attending the Melbourne Sexual Health Centre, Australia, between 31 July 2014 and 30 June 2015. Multivariate logistic regression was conducted to examine the associations between sources of meeting partners and the two aforementioned sexual practices. MSM who used smartphone dating applications were 1.78 (95% CI: 1.38-2.28) times more likely to get rimmed, and 1.63 (95% CI: 1.27-2.09) times more likely to use partner's saliva as a lubricant during anal sex, compared to other sources, after adjusting for age and other sources for meeting partners. These practices are highly associated with gonorrhoea.

The role of older siblings in the sexual and reproductive health of Mexican-origin young women in immigrant families

In the USA, young people of Mexican-origin are more economically disadvantaged and experience higher birth rates than many other Latino groups. In this paper, we examine the influence of older siblings on the sexual and reproductive health of Mexican-origin immigrant women. Qualitative data were drawn from life history interviews with 21 first- and second-generation Mexican-origin women, aged 27-41 years old, resident in the Metro Denver area. Data suggest that older siblings may protect younger sisters from risky sexual behaviours through older siblings' responsibility and care for younger siblings, close and supportive sibling relationships, older siblings' advice about both sexual health and academic success, and sibling modelling. These mechanisms appear particularly protective due to the social and economic hardships immigrant families often face. Implications include fostering healthy sibling relationships and involving older siblings more fully in the sexuality education of younger siblings.

Multiple violence victimisation associated with sexual ill health and sexual risk behaviours in Swedish youth

OBJECTIVES

To address the associations between emotional, physical and sexual violence, specifically multiple violence victimisation, and sexual ill health and sexual risk behaviours in youth, as well as possible gender differences.

METHODS

A cross-sectional population-based survey among sexually experienced youth using a questionnaire with validated questions on emotional, physical, and sexual violence victimisation, sociodemographics, health risk behaviours, and sexual ill health and sexual risk behaviours. Proportions, unadjusted/adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

RESULTS

The participants comprised 1192 female and 1021 male students aged 15 to 22 years. The females had experienced multiple violence (victimisation with two or three types of violence) more often than the males (21% vs. 16%). The associations between multiple violence victimisation and sexual ill health and sexual risk behaviours were consistent for both genders. Experience of/involvement in pregnancy yielded adjusted ORs of 2.4 (95% CI 1.5-3.7) for females and 2.1 (95% CI 1.3-3.4) for males, and early age at first intercourse 2.2 (95% CI 1.6-3.1) for females and 1.9 (95% CI 1.2-3.0) for males. No significantly raised adjusted ORs were found for non-use of contraceptives in young men or young women, or for chlamydia infection in young men.

CONCLUSIONS

Several types of sexual ill health and sexual risk behaviours are strongly associated with multiple violence victimisation in both genders. This should be taken into consideration when counselling young people and addressing their sexual and reproductive health.

Recruitment Strategies of Methamphetamine-Using Men Who Have Sex with Men into an Online Survey

Recruiting hidden populations into online research remains challenging. In this manuscript, we report lessons learned from our efforts to recruit methamphetamine-using men who have sex with men. Between July and October 2012, we implemented a four-phase recruitment strategy to enroll a total of 343 methamphetamine-using MSM into an online survey about recent substance use, sexual behavior, and various psychosocial measures. The four phases were implemented sequentially. During phase one, we placed advertisements on mobile applications, and during phase two, we placed advertisements on traditional websites formatted for browsers. During phase three, we used e-mail to initiate snowball recruitment, and during phase four, we used social media for snowball recruitment. Advertisements on mobile devices and websites formatted for browsers proved to be expensive options and resulted in few eligible participants. Our attempts to initiate a snowball through e-mail also proved unsuccessful. The majority (n=320) of observations in our final dataset came from our use of social media. However, participant fraud was a concern, requiring us to implement a strong participant verification protocol. For maximum recruitment and cost-effectiveness, researchers should use social media for recruitment provided they employ strong participant verification protocols.