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Young women (18–25 years) are more likely to engage in pubic hair removal and experience higher rates of negative sexual health outcomes (e.g., sexually transmitted infections [STIs]). Hair removal salons may serve as novel environments for health interventions. The Sexual Health and Esthetician (SHE) Study aimed to better understand the pubic hair removal profession, explore the esthetician–client relationship, and assess potential for esthetician offices/salons serving as health promotion/sexual health promotion intervention settings. Using an exploratory qualitative design, in-depth interviews (N = 28) were conducted with licensed estheticians who provided pubic waxing services. In a large urban area in Southern California, the catchment area of salons included five unique neighborhoods, each with high reported STI rates. Data were analyzed using a social constructivist perspective and emergent themes from interviews. Synthesis of data showed estheticians provide a variety of waxing services for young women; during appointments, sex-related discussions occur, creating “sexy spaces” where otherwise taboo conversations happen with ease; they notice clients’ possible health concerns, including STIs, but have no protocols/procedures for handling these occurrences; and interactions with clients often result in the development of an intimate bond. Results indicate estheticians may be effective conveyors of sexual health promotion and risk reduction interventions.

RE-AIM is an implementation science framework that provides a structure to promote data collection and analysis in the domains of Reach, Efficacy/ Effectiveness, Adoption, Implementation, and Maintenance. The RE-AIM approach promotes more data collection and reporting than typical evaluations so potential adopters can determine the potential program fit for their setting. RE-AIM has been used to evaluate a variety of programs; however, there are few resources that provide strategies for conducting a RE-AIM evaluation in the school setting. The purpose of this article is to inform future studies by elucidating experiences conducting a large, complex, multisite, longitudinal RE-AIM evaluation in schools in partnership with the state’s Departments of Education and Health, and to share strategies for overcoming obstacles. With the long-term goal of facilitating the translation of school-based intervention research into practice, we provide key considerations and recommend strategies for school-based RE-AIM evaluation success.

Introduction/Background: No research has been conducted on the relevance of intuitive eating as a promising strategy for sustainable weight management among Latinas. This study translated Tylka and Kroon Van Diest’s (2013) Intuitive Eating Scale-2 (IES-2) into Spanish and employed an exploratory factor analysis (EFA) to examine evidence of validity. Methods: We recruited Latinas from community venues in South San Diego, California to participate in this cross-sectional study. Inclusion criteria were: at least 18 years of age, monolingual Spanish or bilingual English/Spanish speaker, and self-identified Latina. In total, 150 Latinas completed a structured, face-to-face interview, which included the Spanish IES-2. Data were used in conducting an EFA. Results: Four items were removed for not loading on the initial EFA. Once items were removed, we extracted five factors with Eigenvalues greater than 1, which accounted for almost two-thirds of the variance. Of the four original IES-2 factors, two were retained identically: Reliance on Hunger and Satiety Cues (RHSC) and Body-Food Choice Congruence (B-FCC). The Eating for Physical Rather than Emotional Reasons (EPR) subscale lost one item in the initial EFA, and was not unidimensional, resulting in two separate subscales. Evidence of score reliability was marginal to strong (α = 0.63 - 0.87). Discussion: This study is first to provide evidence of validity and reliability for a Spanish translation of the IES-2. The results suggest that the proposed Spanish IES-2 can be used to study intuitive eating behaviors and attitudes among Latinas. However, further research with larger sample sizes and other diverse populations are suggested.

Genital human papilloma virus (HPV) is the most common sexually transmitted virus in the US. Effective HPV vaccines remain controversial and have poor uptake among many adolescent groups. Social media have potential for promoting the HPV vaccine, but little is known about the content or sentiment of social media discussions regarding the vaccine. The purpose of this study was to examine message, context, sentiment, and source characteristics of original HPV- and HPV vaccine-related Twitter posts (tweets) over a 3-month time period. This content mining study used publicly available data purchased from Twitter. One-thousand tweets were randomly selected from a sample of 45,260 English language tweets matching our search criteria and collected from December 2014-January 2015. Tweets were manually coded according to source, context, message, and sentiment characteristics using a coding document developed from previous research. Individuals posted just over half (55%) of tweets, whereas organizations posted 40%. More than half (57%) of all coded tweets were positive, and less than one-fifth were negative. Organizations’ tweets were more likely to be positive than individuals’ tweets. A temporal display of contextual events and tweet spikes demonstrates that positive tweets can increase during newsworthy events (e.g. FDA approval of Gardisil 9). The HPV vaccine was most often discussed under a cancer prevention message frame. In contrast with some existing research, discussions surrounding the HPV vaccine in original Twitter posts are largely positive. Our study reveals opportunities for adolescent health specialists to provide accurate, positive HPV vaccination information via Twitter.

Objective: This study evaluated the longitudinal impact of the Teen Outreach Programme (TOP) on adolescent pregnancy, sexual behaviour, risky sex and sexual intentions in non-metropolitan high schools. Design: Pair-matched, cluster randomised controlled trial. Setting: Non-metropolitan public high schools in Florida, USA. Methods: TOP was evaluated against the standard school health curriculum content. Young people ( N = 3,836) enrolled in 26 schools were surveyed at baseline (2012), immediate post-programme (2013) and at 1-year follow-up (2014). Most youth were 14 years old and in ninth grade at baseline. Missing data were imputed using a sequential imputation procedure and analysis took place using generalised linear mixed-effects models with logit link function. Results: Post-programme, young people in the treatment group were less likely to report ever having sex, recent sex, recent sex without a condom or intention to have sex in the next year. At 1-year follow-up, programme participants were less likely to report ever having been pregnant or having got someone pregnant. When examining treatment effects by gender, statistically significant differences were found only for female programme participants. Conclusion: Although many protective factors dissipated by second follow-up and were primarily found among female programme participants, TOP has the potential to decrease risky sexual behaviour.

BACKGROUND Almost half (46%) of Americans have used a smart assistant of some kind (eg, Apple Siri), and 25% have used a stand-alone smart assistant (eg, Amazon Echo). This positions smart assistants as potentially useful modalities for retrieving health-related information; however, the accuracy of smart assistant responses lacks rigorous evaluation. OBJECTIVE This study aimed to evaluate the levels of accuracy, misinformation, and sentiment in smart assistant responses to human papillomavirus (HPV) vaccination–related questions. METHODS We systematically examined responses to questions about the HPV vaccine from the following four most popular smart assistants: Apple Siri, Google Assistant, Amazon Alexa, and Microsoft Cortana. One team member posed 10 questions to each smart assistant and recorded all queries and responses. Two raters independently coded all responses (κ=0.85). We then assessed differences among the smart assistants in terms of response accuracy, presence of misinformation, and sentiment regarding the HPV vaccine. RESULTS A total of 103 responses were obtained from the 10 questions posed across the smart assistants. Google Assistant data were excluded owing to nonresponse. Over half (n=63, 61%) of the responses of the remaining three smart assistants were accurate. We found statistically significant differences across the smart assistants (N=103, χ22=7.807, P=.02), with Cortana yielding the greatest proportion of misinformation. Siri yielded the greatest proportion of accurate responses (n=26, 72%), whereas Cortana yielded the lowest proportion of accurate responses (n=33, 54%). Most response sentiments across smart assistants were positive (n=65, 64%) or neutral (n=18, 18%), but Cortana’s responses yielded the largest proportion of negative sentiment (n=7, 12%). CONCLUSIONS Smart assistants appear to be average-quality sources for HPV vaccination information, with Alexa responding most reliably. Cortana returned the largest proportion of inaccurate responses, the most misinformation, and the greatest proportion of results with negative sentiments. More collaboration between technology companies and public health entities is necessary to improve the retrieval of accurate health information via smart assistants.

Background Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships. Objective This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial. Methods About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratified randomization procedure was used to ensure balance in key covariates and screening criteria across intervention groups. Through benchmark intent-to-treat analyses, we will examine the primary outcome of this study—the impact of About Us relative to the standard of care 9 months following the end of the intervention on the prevalence of vaginal or anal sex without condoms in the past 3 months. The secondary outcomes are four-fold: what is the impact of About Us relative to the standard of care 3 and 9 months following the end of the intervention, on (1) the prevalence of abstinence from vaginal or anal sex in the past 3 months, (2) composite scores of relationship communication and positive conflict resolution among participants involved in a relationship at baseline, (3) the prevalence of SBHC service use or information receipt in the past 3 months, and (4) composite scores of condom use intentions and attitudes regarding condoms and other birth control? Additionally, as part of our sensitivity analyses, two additional analyses will be implemented: modified intent-to-treat and complete case analysis. Results This project (ClinicalTrials.gov #NCT03736876) was funded in 2016 through the Family Youth Services Bureau as part of the Personal Responsibility Education Innovative Strategies program. Baseline data collection took place between February 2018 and March 2020, yielding a total of 5 cohorts and 533 study participants: 316 assigned to treatment and 217 assigned to control. Ongoing follow-up data collection continued through May 2021. Conclusions About Us draws on developmental science to create a contextually and developmentally relevant program that addresses motivation and emotional influences in sexual decision-making. The intervention was designed for implementation within SBHCs, an understudied venue for relationship and sexual health promotion interventions. Unfortunately, COVID-19 pandemic restrictions led to school closures, interrupting ongoing programming, and in-person follow-up data collection, which has affected study attrition. Trial Registration ClinicalTrials.gov NCT03736876; https://clinicaltrials.gov/ct2/show/NCT03736876 International Registered Report Identifier (IRRID) DERR1-10.2196/30499

The national teen birth rate is higher in rural compared to urban areas. While national data suggest rural areas may present higher risk for adverse sexual health outcomes among adolescents, it is unknown whether there are differences within the state of Florida. Overall, Florida has poorer sexual health indicators for adolescents compared to national rates. The purpose of this study was to assess differences in sexual behaviors among Florida adolescents by rural-urban community location. This study includes baseline data from a randomized controlled trial conducted in Florida high schools. Of the 6316 participants, 74% were urban and 26% were rural. Participants responded to questions on sexual behaviors, sexual behavior intentions, and demographics. We estimated the effect of rural-urban status on risk outcomes after controlling for demographic variables using generalized linear mixed models. More teens from rural areas reported ever having sex (24.0%) compared to urban teens (19.7%). No significant differences were observed for most of sexual behaviors assessed. Nonetheless, urban participants were less likely to intend to have sex without a condom in the next year compared to rural participants (aOR = 0.76, 95% CI 0.63-0.92). Overall, there were no major differences in sexual behaviors between rural and urban adolescents in Florida. However, sexual intentions differed between rural and urban adolescents; specifically, rural adolescents were more likely to intend to have sex without a condom in the next year compared to urban adolescents. Understanding the specific disparities can inform contraception and sexual health interventions among rural youth.

This study investigated variables within the Integrative Model of Behavioral Prediction (IMBP) as well as differences across socioeconomic status (SES) levels within the context of inconsistent contraceptive use among college women.A nonprobability sample of 515 female college students completed an Internet-based survey between November 2014 and February 2015.Respondents were asked about their contraception use, knowledge and information sources, demographic information, and IMBP factors, including attitudes, norms, and perceived behavioral control (PBC).While overall attitudes, norms, PBC, and intentions for contraceptive use were high, only 46.8% of women used contraception consistently. Data also revealed only moderate levels of knowledge about contraception. While there were no differences across SES levels for attitudes, PBC, norms or knowledge, SES levels did differ in sources used to acquire contraceptive information.This study highlights the need to consider where college women acquire contraceptive information which is associated with SES.

BACKGROUND For many emerging adults, the transition to college can mark a critical life stage with increased risk for weight gain and obesity, the results of which may bring early onset of chronic disease and mortality. Weight gain among college students is a well-documented phenomenon, with current estimates placing the prevalence of obesity among college students in the United States at around 30%. Digital wearable devices may offer a promising solution toward further addressing the issue of weight gain and obesity. Wearables are defined as devices, accessories or clothing items utilizing computer and electronic technology to track, monitor and/or detect symptoms, behaviors or other health outcomes, and include pedometers, Fitbits or other activity/sleep monitoring bands or devices and smart phone apps used for health tracking and goal-setting. OBJECTIVE This paper reports on college students’ engagement with health tracking wearable devices including their specific device uses, intentions of use, satisfaction, and perception of benefits. We further explored characteristics of students who initiate and sustain use of their devices for longer than six months. METHODS Participants included undergraduate students at a large, urban public university in the Southwestern USA in 2017. A cross-sectional survey was administered and assessed college students’ use and perceptions of health tracking wearables. Method: Descriptive statistics summarize the data on participants’ common responses to device use and perceptions. Bivariate correlations were employed to identify characteristics of respondents who initiate and sustain engagement. RESULTS 86% of respondents currently or previously owned a digital health wearable device. Less than 1% reported that they have never owned a device and would not be interested in ever owning one. Cell phone apps were the most commonly used device, followed by fitness tracking bands. Devices were most frequently used to track steps or exercise routine (81%), diet, calories, or weight (54%), and sleep (26%). About half of wearable users (48%) reported that they share data they collect, socially, from their wearables. It was found that high perceived usefulness and satisfaction, exercise levels, and high perception of social norms were statistically significantly correlated with sustained use. CONCLUSIONS In using wearables among college students to promote long-term healthy behavior changes, there are opportunities to utilize the critical roles that perceived social norms and perceived usefulness of a device can have on one’s long-term behaviors while emphasizing any enjoyable user experiences created by these devices.

Background There is still an HIV epidemic in the United States, which is a substantial issue for populations bearing a disproportionate burden of HIV infections. Daily oral pre-exposure prophylaxis (PrEP) has proven to be safe and effective in reducing HIV acquisition risk. However, studies document that PrEP awareness/usage is low. There is also limited understanding of social media platforms, such as Instagram, as PrEP information sources. Objective Given the paucity of research on PrEP-related Instagram posts and popularity of this social media platform, the purpose of this research is to describe the source characteristics, image types, and textual contents of PrEP-related posts on Instagram. Methods Using Crowdtangle Search, a public insights tool owned/operated by Facebook, we retrieved publicly accessible and English-language-only Instagram posts for the 12-month period preceding April 22, 2020, using the following terms: Truvada or “pre-exposure prophylaxis” or #truvada or #truvadaprep or #truvadawhore or #truvadaforprep. We employed a qualitative coding methodology to manually extract information from posts. Using a pretested codebook, we performed content analysis on 250 posts, examining message and source characteristics (ie, organization type [eg, government, news] and individual type [eg, physician]), including information about PrEP (eg, how it works, cost), and indicated users. Frequencies and percentages were calculated for all categorical variables. A Chi-square test was conducted to determine differences between source types on a variety of message characteristics. Results Three-quarters of the posts (193/250, 77.2%) were posted by organizations. Of the 250 posts reviewed, approximately two-thirds (174/250, 69.6%) included a photograph, more than half (142/250, 56.8%) included an infographic, and approximately one-tenth (30/250, 12%) included a video. More than half defined PrEP (137/250, 54.8%), but fewer posts promoted PrEP use, explained how PrEP works, and included information on the effectiveness of PrEP or who can use it. The most commonly hashtagged populations among posts were men who have sex with men (MSM), but not necessarily bisexual men. Few posts contained race-/ethnicity-related hashtags (11/250, 4.4%). Fewer posts contained transgender-associated tags (eg, #transgirl; 5/250, 2%). No posts contained tags related to heterosexuals or injection drug users. We found statistical differences between source types (ie, individual versus organization). Specifically, posts from organizations more frequently contained information about who can use PrEP, whereas posts from individuals more frequently contained information describing adverse effects. Conclusions This study is among the first to review Instagram for PrEP-related content, and it answers the National AIDS Strategy’s call for a clearer articulation of the science surrounding HIV risk/prevention through better understanding of the current public information environment. This study offers a snapshot of how PrEP is being discussed (and by whom) on one of the most popular social media platforms and provides a foundation for developing and implementing PrEP promotion interventions on Instagram.

Purpose We evaluated the impact of a positive youth development program on adolescent pregnancy, sexual behavior, risky sex, and intentions in nonmetropolitan Florida high schools. Methods Between 2012 and 2014, the Teen Outreach Program (TOP) was compared to standard school curriculum content using a cluster randomized controlled trial design with 7,976 youth in two cohorts. The majority of youth were 14 years old and in the ninth grade at baseline. Treatment group youth received TOP in health-related classes. After using multiple imputation to account for missing data, we analyzed baseline and follow-up survey data using generalized linear mixed-effects models with logit link function. Results In the cohort 1 sample, compared to the control condition, males and females receiving TOP showed lower odds of engaging in recent sex (odds ratio [OR], .71; 95% confidence interval [CI]: .58–.86) compared to control males and females. Cohort 1 treatment females who did engage in recent sex were less likely to have risky sex (OR, .54; 95% CI: .32–.89). There were fewer significant findings in cohort 2, though TOP females and combined gender had lower odds of risky sex intentions (OR, .53; 95% CI: .33–.84 and OR, .65; 95% CI: .44–.96, respectively). Overall, cohort 1 females in the TOP condition were the group most likely to benefit from TOP. Conclusions Consistent with previous research, TOP was more effective regarding sexual health outcomes among female versus male youth; this was especially true for the outcome of risky sex. However, results were not consistent across cohorts, prompting questions for future research.

Objective: This paper reports on a pilot study evaluating the feasibility and acceptability of a text- and mobile video–based intervention to educate women and men attending college about non-daily contraception, with a particular focus on long-acting reversible contraception (LARC). A secondary objective is to describe the process of intervention development. Setting: Participants included undergraduate students attending a large urban US university between September and November 2011. Design: Using a participatory research strategy, investigators developed, delivered and evaluated a pilot mobile intervention using a texting interface, mobile videos and a contraceptive provider directory. Method: Descriptive statistics summarise the data collected from daily text-in analytics and web-based survey responses. Results: The texting interface received 1,203 visits; mobile videos were accessed 446 times. The provider directory was used by 10% of participants. Survey respondents’ ( N = 82) motivation for choosing non-daily contraception included cost (57%), side effects (55%), effectiveness (55%) and low recall effort (23%). Most participants (88%) would/might recommend these methods to others. Conclusion: This study demonstrated that text- and mobile video–based modalities are appropriate and feasible to deliver contraceptive education to college students. There is a critical opportunity to reach large numbers of potential users through mobile health (mHealth) interventions to disseminate accurate information and link to healthcare services.

This narrative review examined the following research questions: 1) What are the characteristics and outcomes of social media-based diet/weight loss studies to date? 2) What are the methodological characteristics of social media-based diet/weight loss studies? 3) What research strengths and limitations exist among social media-based diet/weight loss studies? We conducted a narrative review of studies related to diet, weight loss, and social media. Out of 37 included articles, most focused exclusively on Facebook (n = 13, 35%) or Twitter (n = 12, 32%). Of 20 studies (54%) analyzing social media content, most analyzed textual content (n = 13, 65%). About half of studies (n = 20, 54%) had no guiding theoretical framework, and about one-quarter used Social Cognitive Theory (SCT) (n = 10, 27%). Studies designs used were non-experimental (n = 15, 41%), experimental (n = 12, 32%), qualitative (n = 8, 22%), and mixed methods (n = 2, 5%). Intervention research thus far has consisted mostly of inadequately controlled and powered pilot studies. More rigorous randomized controlled trials should be conducted that build on data gathered from pilot research. Further research on how exposure to/interaction with diet/weight loss social media translates to individual behavior change will aid in addressing the US's obesity epidemic.

Background Almost half (46%) of Americans have used a smart assistant of some kind (eg, Apple Siri), and 25% have used a stand-alone smart assistant (eg, Amazon Echo). This positions smart assistants as potentially useful modalities for retrieving health-related information; however, the accuracy of smart assistant responses lacks rigorous evaluation. Objective This study aimed to evaluate the levels of accuracy, misinformation, and sentiment in smart assistant responses to human papillomavirus (HPV) vaccination–related questions. Methods We systematically examined responses to questions about the HPV vaccine from the following four most popular smart assistants: Apple Siri, Google Assistant, Amazon Alexa, and Microsoft Cortana. One team member posed 10 questions to each smart assistant and recorded all queries and responses. Two raters independently coded all responses (κ=0.85). We then assessed differences among the smart assistants in terms of response accuracy, presence of misinformation, and sentiment regarding the HPV vaccine. Results A total of 103 responses were obtained from the 10 questions posed across the smart assistants. Google Assistant data were excluded owing to nonresponse. Over half (n=63, 61%) of the responses of the remaining three smart assistants were accurate. We found statistically significant differences across the smart assistants (N=103, χ22=7.807, P=.02), with Cortana yielding the greatest proportion of misinformation. Siri yielded the greatest proportion of accurate responses (n=26, 72%), whereas Cortana yielded the lowest proportion of accurate responses (n=33, 54%). Most response sentiments across smart assistants were positive (n=65, 64%) or neutral (n=18, 18%), but Cortana’s responses yielded the largest proportion of negative sentiment (n=7, 12%). Conclusions Smart assistants appear to be average-quality sources for HPV vaccination information, with Alexa responding most reliably. Cortana returned the largest proportion of inaccurate responses, the most misinformation, and the greatest proportion of results with negative sentiments. More collaboration between technology companies and public health entities is necessary to improve the retrieval of accurate health information via smart assistants.

The current study examined conversations on Twitter related to use and perceptions of e-cigarettes in the United States. We employed the Social Media Analytic and Research Testbed (SMART) dashboard, which was used to identify and download (via a public API) e-cigarette-related geocoded tweets. E-cigarette-related tweets were collected continuously using customized geo-targeted Twitter APIs. A total of 193,051 tweets were collected between October 2015 and February 2016. Of these tweets, a random sample of 973 geocoded tweets were selected and manually coded for information regarding source, context, and message characteristics. Our findings reveal that although over half of tweets were positive, a sizeable portion was negative or neutral. We also found that, among those tweets mentioning a stigma of e-cigarettes, most confirmed that a stigma does exist. Conversely, among tweets mentioning the harmfulness of e-cigarettes, most denied that e-cigarettes were a health hazard. These results suggest that current efforts have left the public with ambiguity regarding the potential dangers of e-cigarettes. Consequently, it is critical to communicate the public health stance on this issue to inform the public and provide counterarguments to the positive sentiments presently dominating conversations about e-cigarettes on social media. The lack of awareness and need to voice a public health position on e-cigarettes represents a vital opportunity to continue winning gains for tobacco control and prevention efforts through health communication interventions targeting e-cigarettes.

Purpose Using the Internet to meet new people is becoming more common; however, such behavior is often considered risky, particularly for adolescents. Nevertheless, adolescents are meeting people through online venues and some are forming romantic/sexual relationships. The purpose of this study was to examine the relationship and sexual satisfaction reported by teens in online- and offline-initiated relationships. Methods Data were collected from 273 13–19 year olds visiting a publicly funded clinic through 2010 and 2011. Questions included where respondents met the partner (online vs. offline), time between meeting and first sex, how well they knew the partner, and relationship and sexual (R&S) satisfaction. Analyses consisted of descriptive statistics, t tests, and path analysis, exploring R&S satisfaction in online- and offline-initiated relationships. Results R&S satisfaction scores were moderate for adolescents who reported meeting partners online and in person but were statistically higher in offline-initiated relationships. There was an inverse relationship between having an online partner and both relationship and sexual satisfaction. Additionally, knowing partners for a longer period of time and feeling more knowledgeable about partners before having sex were statistically significantly related to higher R&S satisfaction. Conclusions Teens in this study reported more satisfying relationships with partners met offline compared with online. Results suggest that encouraging teens to wait longer and to get to know their partner(s) better before engaging in sex may improve satisfaction with, and quality of, those relationships. These findings provide an important contribution to sexual health promotion among young people, with whom technology use is ubiquitous.

Assess long-acting reversible contraceptive (LARC) and other contraceptive use trends, identify LARC use predictors, and examine dual method use.Women in the American College Health Association-National College Health Assessment (ACHA-NCHA) II, aged 18-24 years, who reported having vaginal sex (N = 37,899).Secondary analyses of Fall 2011-2014 ACHA-NCHA II data.Statistically significant increases in LARC usage and, specifically, implant usage, were found. Characteristics associated with LARC use included age, race/ethnicity, relationship status, and school type. Students reporting LARC use had lower odds of condom usage compared with non-LARC hormonal method users.This analysis of LARC predictors and dual LARC/condom use has implications for research and health promotion efforts. Findings suggest that college health services are well positioned to meet the sexual and reproductive health needs of diverse populations of students. College health professionals should elicit students' individual and/or relationship priorities to tailor messaging/services offered for pregnancy/STI prevention.

The author presents an introduction to the special issue on teenage sexual health and unplanned pregnancy. He mentions the research presented on programs that attempt to lower unplanned teenage pregnancies, the need for more programs, and the need to reach a greater service population.

Objectives. To determine if the Teen Outreach Program (TOP), a youth development and service learning program, can reduce sexual risk-taking behaviors compared with a business as usual or benign counterfactual. Methods. We synthesized results of 5 independent studies conducted in 5 geographically and ethnically diverse locations between 2011 and 2015 with 17 194 middle and high school students. Each study cluster-randomized classes, teachers, or schools to treatment or control groups and included the students enrolled in those clusters at baseline in an intent-to-treat analysis. Multilevel models tested impacts on recent sexual activity, recent unprotected sexual activity, and sexual initiation among the sexually inexperienced at baseline at approximately 1 and 2 years after baseline. Results. Precision-weighted average effect sizes showed nonsignificant reductions of 1 percentage point or less in recent sexual activity (5 studies: −0.6; P = .32), recent unprotected sex (5 studies: −0.2; P = .76), and sexual initiation (4 studies: −1.1; P = .10) after 1 year. Conclusions. There was little evidence of the effectiveness of TOP in reducing sexual risk-taking behaviors. Results underscored the importance of continually evaluating evidence-based programs that have previously been shown to be effective.

The objective of the current study was to quantify the behavioral intentions of young adult male sexual minorities (MSM) to initiate human papillomavirus (HPV) vaccination and test an integrative model of HPV vaccine decision making. Participants were 575 MSM who were residing in the United States and were between ages 18 and 26 years. Standard direct and indirect measures of attitudes, perceived norms, and perceived behavioral control were employed to explain variation in behavioral intention. Additional background factors—such as concealment of one’s sexual identity, suspicion of health care provider competence in LGBT health issues, perceived threat, and information orientation—were also included in the model. The final model fit the data well and identified a set of salient attitudinal and control beliefs as the strongest determinants of intention ( R2 = .38). Perceived threat and information orientation were positively correlated with HPV-related beliefs. Perceived threat was higher among men infected with HIV and lower among men in monogamous relationships. Self-efficacy, as an indirect measure of perceived behavioral control, was inversely related to the general tendency to conceal aspects of one’s sexual orientation and a suspicion of health care providers. Bisexual identified men were more likely to conceal their sexual orientation and be more suspicious of health care providers. In this study, a number of modifiable determinants of HPV vaccine intentions—both psychosocial and environmental—were identified and have implications for targeted and tailored behavioral interventions to promote HPV vaccination among MSM.

Preventing risky sexual health behavior in adolescents has become a critical focus among public health professionals, educators, and policy makers in the USA, and for good reason. Risky sexual behavior contributes to unintended pregnancy and sexually transmitted infections (STIs), including HIV/AIDS. Such outcomes are highly related to the overall physical, social/emotional, academic, and economic well-being of adolescents, children born to teens, and society as a whole. This chapter addresses the prevention of risky sexual health behavior in adolescents in four sections. In the first section, we summarize the epidemiology of risky sexual behavior among adolescents, focusing on statistics of adolescent pregnancy, STIs, and HIV/AIDS in the USA, and the economic and social costs of risky adolescent sexual behavior. In the second section, we discuss the relationship between risky sexual behavior and behavioral theory and why maintaining a focus on behavioral theory in prevention programming is critical. In the third section, we identify venues where interventions designed to prevent risky sexual behavior among adolescents can be implemented, including schools, community settings, and clinical settings, and provide examples of evidence-based programs designed to be implemented in each of these settings. In the fourth and final section, we present recommendations for future prevention programming, provide guidance on developing effective programs, and list helpful resources for planning prevention programs, including planning frameworks such as intervention mapping, RE-AIM, and PRECEDE-PROCEED.