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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.

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.

Globally, and in the United States (U.S.) specifically, rates of reported sexually transmitted infections (STIs) have been steadily increasing and are especially high among youth aged 13–25 years. Using condoms correctly and consistently is an effective STI prevention measure for sexually active youth, yet public health endeavors tend to focus only on condom use consistency. Directly measuring condom application is challenging and expensive. Alternative tools evaluate this behaviour, but little evidence exists on the appropriateness of these instruments in measuring application skills. This systematic review and meta-analysis examined the association between condom application skills and self-efficacy. We conducted a search of several databases as well as unpublished works. Studies were included if they were in English, examined youth aged 13–25 years, and were available between 1992 and 2019. The authors screened 630 titles and abstracts for initial inclusion criteria. A full-text review of 30 studies was conducted. The authors included 19 studies in the systematic review and 5 studies were included in the meta-analysis. Both a fixed- and random-effects model (Q = .2321, I2 = 0%) yielded a medium-sized statistically non-significant association (r = 0.217) between skills and self-efficacy. Despite the small sample size, findings suggest that skills and self-efficacy may not be as interchangeable as previously assumed when assessing condom application. Implications for future research are discussed.

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.

Purpose Among a sample of adolescent girls, we assessed: 1) prevalence of sexual harassment by type, place of occurrence, and perpetrators; 2) association with substance use and poor mental health outcomes; and 3) the proportion of girls experiencing sexual harassment in more than one place and relation to study outcomes. Methods We collected survey data from 159 sexually active girls (aged 15–19 years) recruited from an urban health clinic in Southern California. We used multivariable regression models to assess associations between sexual harassment in the past 6 months and the following outcomes: 1) substance use in past 30 days (alcohol use, binge drinking, and marijuana use, respectively); 2) other drug use ever; and 3) feelings of depression and anxiety, respectively, in past 30 days. Results Almost two-thirds of girls (65.4%) reported experiencing sexual harassment in the past 6 months. Among those reporting recent harassment (n = 104), the abuse most frequently occurred in public spaces (on public transport [50.5%], at school [42.7%], and in their neighborhoods [39.8%]) and most often in the form of sexual comments, jokes, or gestures (57.2%), although 12.6% were “touched, grabbed, or pinched in a sexual way.” The vast majority (82.7%) did not know the perpetrators (82.7%). Experiences of sexual harassment in the past 6 months were significantly associated with alcohol use (odds ratio [OR], 4.5; 95% confidence interval [CI], 2.0–10.2), binge drinking (OR, 4.2; 95% CI, 1.8–9.8), and marijuana use (OR, 2.6; 95% CI, 1.2–5.7) in the past 30 days; other drug use ever (OR, 5.4; 95% CI, 1.8–16.4); and feelings of depression (OR: 2.7; 95%CI: 1.3–5.5) and anxiety (OR: 2.6; 95%CI: 1.2–5.5) in the past 30 days. Just over half (55.3%) reported sexual harassment in more than one place, which was also associated with poor substance use and mental health outcomes. Conclusions Findings suggest that sexual harassment experiences are pervasive, occur in girls' immediate and everyday environments, and are associated with girls’ substance use and adverse mental health outcomes., Highlights • We found a high prevalence of recent experiences of sexual harassment (65%) among this clinic-based sample of girls. • Victimization is largely occurring in girls’ immediate environments and predominantly perpetrated by strangers. • Sexual harassment was associated with substance use, as well as depression and anxiety among adolescent girls.

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.

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.

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.

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.

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.

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.