Search

Adolescents' health behaviors and experiences contribute to many outcomes, including risks for HIV, other sexually transmitted diseases, and unintended pregnancy. Public health interventions and approaches addressing risk behaviors or experiences in adolescence have the potential for wide-reaching impacts on sexual health and other related outcomes across the lifespan, and schools are a critical venue for such interventions. This paper describes a school-based program model developed by the Centers for Disease Control and Prevention's Division of Adolescent and School Health for preventing HIV/sexually transmitted diseases, unintended pregnancy, and related health risk behaviors and experiences among middle and high school students. This includes a summary of the theoretical and evidence base that inform the model, and a description of the model's activities, organized into three key strategies (sexual health education, sexual health services, and safe and supportive environments) and across three cross-cutting domains (strengthening staff capacity, increasing student access to programs and services, and engaging parent and community partners). The paper also outlines implications for adolescent health professionals and organizations working across schools, clinics, and communities, to address and promote adolescent sexual health and well-being.

Background Since COVID-19 was declared a pandemic in March 2020, nearly 93% of US students engaged in some distance learning. These school disruptions may negatively influence adolescent mental health. Protective factors, like feeling connected to family or school may demonstrate a buffering effect, potentially moderating negative mental health outcomes. The purpose of the study was to test our hypothesis that mode of school instruction influences mental health and determine if school and family connectedness attenuates these relationships. Methods The COVID Experiences Survey was administered online or via telephone October –November 2020 to adolescents ages 13-19 using NORC’s AmeriSpeak Panel, a probability-based panel recruited using random address-based sampling with mail and telephone non-response follow-up. The final sample included 567 adolescents in grades 7-12 who received virtual, in person, or combined instruction. Unadjusted and adjusted associations among four mental health outcomes and instruction mode were measured, and associations with school and family connectedness were explored for protective effects. Results Students attending school virtually reported poorer mental health than students attending in-person. Adolescents receiving virtual instruction reported more mentally unhealthy days, more persistent symptoms of depression, and a greater likelihood of seriously considering attempting suicide than students in other modes of instruction. After demographic adjustments school and family connectedness each mitigated the association between virtual vs. in-person instruction for all four mental health indicators. Conclusion As hypothesized, mode of school instruction was associated with mental health outcomes, with adolescents receiving in-person instruction reporting the lowest prevalence of negative mental health indicators. School and family connectedness may play a critical role in buffering negative mental health outcomes.

In March 2020, efforts to slow transmission of SARS-CoV-2, the virus that causes COVID-19, resulted in widespread closures of school buildings, shifts to virtual educational models, modifications to school-based services, and disruptions in the educational experiences of school-aged children. Changes in modes of instruction have presented psychosocial stressors to children and parents that can increase risks to mental health and well-being and might exacerbate educational and health disparities (1,2). CDC examined differences in child and parent experiences and indicators of well-being according to children's mode of school instruction (i.e., in-person only [in-person], virtual-only [virtual], or combined virtual and in-person [combined]) using data from the COVID Experiences nationwide survey. During October 8-November 13, 2020, parents or legal guardians (parents) of children aged 5-12 years were surveyed using the NORC at the University of Chicago AmeriSpeak panel,* a probability-based panel designed to be representative of the U.S. household population. Among 1,290 respondents with a child enrolled in public or private school, 45.7% reported that their child received virtual instruction, 30.9% in-person instruction, and 23.4% combined instruction. For 11 of 17 stress and well-being indicators concerning child mental health and physical activity and parental emotional distress, findings were worse for parents of children receiving virtual or combined instruction than were those for parents of children receiving in-person instruction. Children not receiving in-person instruction and their parents might experience increased risk for negative mental, emotional, or physical health outcomes and might need additional support to mitigate pandemic effects. Community-wide actions to reduce COVID-19 incidence and support mitigation strategies in schools are critically important to support students' return to in-person learning.

OBJECTIVES National guidelines call for annual testing for certain sexually transmitted infections (STIs) among specific adolescent populations, yet we have limited population-based data on STI testing prevalence among adolescents. With inclusion of a new item in the 2019 national Youth Risk Behavior Survey, we provide generalizable estimates of annual STI testing among sexually active high school students. METHODS We report weighted prevalence estimates of STI testing (other than HIV) in the past 12 months among sexually active students (n = 2501) and bivariate associations between testing and demographic characteristics (sex, age, race and ethnicity, sexual identity, and sex of sexual contact). Multivariable models stratified by sex and adjusted for demographics examine the relationships between testing and sexual behaviors (age of initiation, number of sex partners, condom nonuse at last sexual intercourse, and substance use at last sexual intercourse). RESULTS One-fifth (20.4%) of sexually active high school students reported testing for an STI in the previous year. A significantly higher proportion of female (26.1%) than male (13.7%) students reported testing. Among female students, prevalence differed by age (≤15 years = 12.6%, age 16 = 22.8%, age 17 = 28.5%, or ≥18 years = 36.9%). For male students, there were no differences by demographic characteristics, including sexual identity, but most sexual risk behaviors were associated with increased likelihood of STI testing (adjusted prevalence ratios ranging from 1.48 to 2.47). CONCLUSIONS Low prevalence of STI testing suggests suboptimal adherence to national guidelines, particularly for sexually active adolescent females and young men who have sex with men who should be tested for Chlamydia and gonorrhea annually.

Confidentiality protections are a key component of high-quality adolescent sexual and reproductive health (SRH) care. Research has shown that adolescents value confidentiality and are more likely to seek care and provide honest information when confidentiality protections are implemented. However, many adolescents do not receive confidential SRH care. We synthesize studies of adolescents, parents, and providers to identify confidentiality-related factors that may explain why adolescents do not seek care or receive confidential services when they do access care. We present themes relevant to each population that address individual-level knowledge, attitudes, and behaviors, as well as clinic-level characteristics such as protocols, billing mechanisms, and clinic type. These findings have the potential to inform intervention efforts to improve the delivery of confidential SRH care for young people.

BACKGROUND In an attempt to increase high school students' sexually transmitted disease (STD) testing rates, the Centers for Disease Control and Prevention's Division of Adolescent and School Health partnered with ICF and Chicago Public Schools to adapt and implement the "GYT: Get Yourself Tested" health marketing campaign for a high school. METHODS Clinic record data and student retrospective self-report surveys (n = 193) tested for differences between the GYT intervention school and a comparison school on a number of outcomes, including human immunodeficiency virus and STD testing. RESULTS Clinic record data showed that testing increased significantly more for the intervention than the comparison school during the GYT implementation period (B, 2.9; SE, 1.1, P < 0.05). Furthermore, the odds of being tested at the referral clinic were more than 4 times (odds ratio, 4.4) as high for students in the campaign school than for those in the comparison school (95% confidence interval, 2.3-8.2). Survey data did not show increased self-reported testing but, more students in the GYT school (92.7%) were aware of where to receive free, low-cost, or affordable human immunodeficiency virus and STD testing than students in the comparison school (76.0%; P < 0.01). Among sexually experienced students (n = 142), significantly more from the campaign school reported that they intended to test for STDs in the next 3 months (48.4% strongly agree and 33.2% agree) compared with those at the comparison school (27.4% strongly agree and 32.9% agree; P < 0.05). CONCLUSIONS Our pilot suggests that a student-led GYT campaign in high schools may successfully increase STD testing of students. Although some of the findings from this pilot evaluation are promising, they are limited, and broader implementation and evaluation is needed. Future evaluation efforts can include more rigorous study designs, multiple schools or districts, longer campaign and evaluation across an entire school or calendar year, or in combination with other school-based testing strategies like a mass school-based screening event.

Introduction Given mixed findings regarding the relationship between long-acting reversible contraception and condom use, this systematic review and meta-analysis synthesizes studies comparing sexually transmitted infection‒related outcomes between users of long-acting reversible contraception (intrauterine devices, implants) and users of moderately effective contraceptive methods (oral contraceptives, injectables, patches, rings). Methods MEDLINE, Embase, PsycINFO, Global Health, CINAHL, Cochrane Library, and Scopus were searched for articles published between January 1990 and July 2018. Eligible studies included those that (1) were published in the English language, (2) were published in a peer-reviewed journal, (3) reported empirical, quantitative analyses, and (4) compared at least 1 outcome of interest (condom use, sexual behaviors other than condom use, sexually transmitted infection‒related service receipt, or sexually transmitted infections/HIV) between users of long-acting reversible contraception and users of moderately effective methods. In 2020, pooled ORs were calculated for condom use, chlamydia/gonorrhea infection, and trichomoniasis infection; findings for other outcomes were synthesized qualitatively. The protocol is registered on the International Prospective Register of Systematic Reviews (CRD42018109489). Results A total of 33 studies were included. Long-acting reversible contraception users had decreased odds of using condoms compared with oral contraceptive users (OR=0.43, 95% CI=0.30, 0.63) and injectable, patch, or ring users (OR=0.58, 95% CI=0.48, 0.71); this association remained when limited to adolescents and young adults only. Findings related to multiple sex partners were mixed, and only 2 studies examined sexually transmitted infection testing, reporting mainly null findings. Pooled estimates for chlamydia and/or gonorrhea were null, but long-acting reversible contraception users had increased odds of trichomoniasis infection compared with oral contraceptive users (OR=2.01, 95% CI=1.11, 3.62). Discussion Promoting condom use specifically for sexually transmitted infection prevention may be particularly important among long-acting reversible contraception users at risk for sexually transmitted infections, including adolescents and young adults.

PURPOSE: The purpose of this study was to describe whether adolescent and young adult patients truthfully disclose sexual activity to providers during a sexual history and explore associations between disclosure and receipt of recommended services. METHODS: Data from the 2018 National Survey of Sexual Health and Behavior were used to describe self-reported disclsoure of sexually active 14- to 24-year-olds who had a health care visit in the previous year where a sexual history was taken (n = 196). We examined bivariate associations between disclosure and age, race/ethnicity, sex, sexual identity, and receipt of sexual health services. RESULTS: Most (88%) respondents reported telling their provider the truth about sexual activity. A higher proportion of the younger adolescents (14- to 17-year-olds) did not disclose compared with the 18- to 24-year-old respondents (25.4% vs 3.9%; p < .001). A higher proportion of patients who disclosed reported having a sexually transmitted disease test (69.6% vs 26.7%; p < .001); being offered a sexually transmitted disease test (44.3% vs 4.5%; p < .001); and being asked by providers about number of partners (54.3% vs 15.4%; p < .01). CONCLUSIONS: Most young patients disclose their sexual history to their provider, but younger patients might be less likely to do so. Positive patient-provider relationships may encourage disclosure of sexual activity and support receipt of indicated sexual and reproductive health services.

Objective This study assesses provider communication with adolescent and young women about birth control, emergency contraception and condoms during sexual and reproductive health visits. Study design Using data from sexually active 15–24-year-old women in the 2011–2015 National Survey of Family Growth, we examined provider communication about contraception and condoms at sexual and reproductive health services in the past year and assessed differences by demographics, sexual behavior and source of care. Results Approximately two thirds of women received provider communication about condoms (65.0%) and birth control (64.0%–66.8%). Communication was higher among Title-X-funded clinic vs. private providers. Differences by age, race/ethnicity, mother’s education, number of partners and condom use were also found. Conclusion Most sexually active young women attending sexual and reproductive health visits received provider communication about condoms and birth control, but communication is not universal and varies by source of care, demographics and sexual behavior.

We describe school-based screening events in four Detroit, Michigan public high schools. To examine trends, we analyzed Chlamydia trachomatis data from 2010 to 2015. Prevalence of C. trachomatis decreased significantly (P

Access to school health clinics and nurses has been linked with improved student achievement and health. Unfortunately, no studies have examined how many students report using school clinics or nurses and for which services. This study addressed this gap with data from a nationally representative sample of 15- to 25-year-olds. Respondents who reported being in high school were provided a list of services and asked whether they had gone to a school nurse or clinic for any of the listed services. Nearly 90% reported having access to a school clinic or nurse. Among students with access, 65.6% reported using at least one service. Non-White students and younger students were more likely to report having access to a clinic or nurse. These results show many students have access to clinics or nurses and are using these services, although not uniformly for all services.

Purpose Many young people are not aware of their rights to confidential sexual and reproductive health (SRH) care. Given that online health information seeking is common among adolescents, we examined how health education Web content about SRH for young people addresses confidentiality. Methods In Spring 2017, we conducted Google keyword searches (e.g., “teens” and “sex education”) to identify health promotion Web sites operated by public health/medical organizations in the United States and providing original content about SRH for adolescents/young adults. Thirty-two Web sites met inclusion criteria. We uploaded Web site PDFs to qualitative analysis software to identify confidentiality-related content and conduct thematic analysis of the 29 Web sites with confidentiality content. Results Sexually transmitted infection testing and contraception were the SRH services most commonly described as confidential. Clear and comprehensive definitions of confidentiality were lacking; Web sites typically described confidentiality in relation to legal rights to receive care without parental consent or notification. Few mentioned the importance of time alone with a medical provider. Only half of the Web sites described potential inadvertent breaches of confidentiality associated with billing and even fewer described other restrictions to confidentiality practices (e.g., mandatory reporting laws). Although many Web sites recommended that adolescents verify confidentiality, guidance for doing so was not routinely provided. Information about confidentiality often encouraged adolescents to communicate with parents. Conclusions There is a need to provide comprehensive information, assurances, and resources about confidentiality practices while also addressing limitations to confidentiality in a way that does not create an undue burden on adolescents or reinforce and exacerbate confidentiality concerns.

Adolescents and young adults are disproportionately affected by sexually transmitted diseases (STDs). This study examined the association of GYT: Get Yourself Tested (GYT), a sexual health social marketing campaign, with several sexual health behaviors on a nationally representative sample of high school (HS) and college students ( n = 2,329) recruited through an online panel survey. Behaviors examined were STD testing, HIV testing, and whether students had communication with health care providers and their romantic partners about STDs and STD testing. Rao-Scott chi-square tests and multivariable logistic regression models were conducted. The results indicated college students were more aware of GYT than HS students. Awareness of GYT was significantly associated with STD testing ( p < .05), HIV testing ( p < .01), and talking with romantic partners ( p < .01) for college students but only with STD testing ( p < .05) and talking to a provider ( p < .05) for HS students. The differences between HS and college students provide insight for those developing and implementing interventions across such a broad age range of youth.

Purpose Long-acting reversible contraceptive (LARC) methods do not require annual clinic visits for continuation, potentially impacting receipt of recommended sexually transmitted infection (STI)/human immunodeficiency virus (HIV) services for young women. We assess service receipt among new and continuing LARC users versus moderately and less effective method users and non-contraceptors. Methods Using 2011–2015 National Survey of Family Growth data from sexually active women aged 15–24 years (n = 2,018), we conducted logistic comparisons of chlamydia, any STI and HIV testing, and sexual risk assessment in the past year by current contraceptive type. Results Less than half of respondents were tested for chlamydia (40.9%), any STI (47.3%), or HIV (25.9%); 66.5% had their sexual risk assessed. Differences in service receipt between new and continuing LARC users as compared with moderately effective method users were not detected in multivariable models, except that continuing LARC users were less likely to be tested for HIV (adjusted prevalence ratio [aPR] = .52, 95% confidence interval [CI] = .32–.85). New, but not continuing, LARC users were more likely than less effective method users (aPR = 1.35, 95% CI = 1.03–1.76) and non-contraceptors (aPR = 1.43, 95% CI = 1.11–1.85) to have their sexual risk assessed, although both groups were more likely than non-contraceptors to be tested for chlamydia (new: aPR = 1.52, 95% CI = 1.08–2.15; continuing: aPR = 1.69, 95% CI = 1.24–2.29). Conclusions We found little evidence that LARC use was associated with lower prevalence of STI testing. However, new, but not continuing, LARC users, as compared with those not using a method requiring a clinic visit, were more likely to have had their risk assessed, suggesting that initiating LARC may offer an opportunity to receive services that does not persist.

Sexual minority youth (SMY) experience elevated rates of adverse sexual health outcomes. Although risk factors driving these outcomes are well studied, less attention has been paid to protective factors that potentially promote health and/or reduce negative effects of risk. Many factors within interpersonal relationships have been identified as protective for the sexual health of adolescents generally. We sought to systematically map the current evidence base of relationship-level protective factors specifically for the sexual health of SMY through a systematic mapping of peer-reviewed observational research. Articles examining at least one association between a relationship-level protective factor and a sexual health outcome in a sample or subsample of SMY were eligible for inclusion. A total of 36 articles reporting findings from 27 data sources met inclusion criteria. Included articles examined characteristics of relationships with peers, parents, romantic/sexual partners, and medical providers. Peer norms about safer sex and behaviorally specific communication with regular romantic/sexual partners were repeatedly protective in cross-sectional analyses, suggesting that these factors may be promising intervention targets. Generally, we found some limits to this literature: few types of relationship-level factors were tested, most articles focused on young sexual minority men, and the bulk of the data was cross-sectional. Future work should expand the types of relationship-level factors investigated, strengthen the measurement of relationship-level factors, include young sexual minority women in samples, and use longitudinal designs. Doing so will move the field toward development of empirically sound interventions for SMY that promote protective factors and improve sexual health.

This study examined predictors of having received HIV and sexually transmitted disease (STD) testing and having been referred by school staff for HIV/STD testing. In 2014, students in seven high schools completed paper-and-pencil questionnaires assessing demographic characteristics, sexual behavior, referrals for HIV/STD testing, and HIV/STD testing. The analytic sample ( n = 11,303) was 50.7% female, 40.7% Hispanic/Latino, 34.7% Black/African American (non-Hispanic), and mean age was 15.86 ( SD = 1.22). After controlling for demographic characteristics, significant predictors of reporting having been tested for HIV or STDs were reporting having received a referral for HIV/STD testing (odds ratio [ OR] = 3.18; 95% CI = [2.14, 4.70]) and reporting staff following-up on the referral ( OR = 3.29; 95% CI = [1.31, 8.23]). Students reporting referrals had significantly higher odds of being male ( OR = 2.49; 95% CI = [1.70, 3.65]), “other” or multiracial (non-Hispanic; compared to White, non-Hispanic; OR = 2.72; 95% CI = [1.35, 5.46]), sexual minority ( OR = 3.80; 95% CI = [2.57, 5.62]), and sexually experienced ( OR = 2.58; 95% CI = [1.76, 3.795]). School staff referrals with follow-up may increase HIV/STD testing among students.

Background and purpose HPV vaccine coverage for females has increased in the U.S., although challenges to achieving high coverage remain. HPV vaccine coverage continues to lag behind that of other routinely recommended adolescent vaccines and these gaps in coverage are widening. To inform strategies to improve uptake, we explore correlates of vaccine intention and describe reasons for refusing HPV vaccination among unvaccinated females in a nationally representative sample of adolescents and young adults during early stages of HPV vaccine availability. Methods In 2007–2008, 1243 females aged 15–24 years were asked about HPV vaccination in the National Survey of Family Growth (NSFG). For unvaccinated women ( n = 955), we evaluated demographic and sexual behavior correlates of likelihood to receive the vaccine in the next 12 months in bivariate and multivariable analyses by age. Correlates to the main reasons for foregoing vaccination are described. Results A minority (42.5%) of unvaccinated respondents said they intended to receive HPV vaccine in the next 12 months: 37.6% of adolescents (15–19 years) and 42.0% of young adults (20–24 years). Sexually experienced women were more than twice as likely as non-sexually experienced women to intend to receive HPV vaccine (15–19 years: aOR = 2.39, 95% CI = 1.15, 4.94; 20–24 years: aOR = 2.17, 95% CI = 1.08, 4.33). Having health insurance was associated with being likely to receive HPV vaccine among adolescents. Hispanic young adults were more likely than non-Hispanic Whites to be likely to receive HPV vaccine. The belief of not being at risk for HPV and institutional barriers were the two most commonly cited reasons for foregoing vaccination.Among unvaccinated women who did not intend to get vaccinated, respondents who never had sex were more likely to report not being at risk as the main reason for not needing the vaccine compared to women with sexual experience (44.5 vs. 24.4%) but this finding was only marginally significant in our limited sample. Conclusion In the first years immediately post-licensure of an HPV vaccine, the majority of unvaccinated women indicated that they were unlikely to seek vaccination. Intent to receive the HPV vaccine is tied to sexual experience and most women who do not intend to get vaccinated and have never had sex believe they are not at risk of HPV or do not need an HPV vaccine. These findings highlight the need to better communicate information regarding lifetime risk for HPV and the importance of receiving HPV vaccine prior to sexual initiation. These findings should inform strategies to increase vaccine uptake.

Vaccines to prevent certain types of human papillomavirus (HPV) and associated cancers are recommended for routine use among young women. Nationally representative reports of vaccine uptake have not explored the relationship between HPV vaccine initiation and various sexual behaviors.Explore sexual behavior and demographic correlates of HPV vaccine initiation from a nationally representative survey of adolescent and young adult women.In 2007-2008, a total of 1243 girls/women aged 15-24 years responded to questions about receiving HPV vaccine in the National Survey of Family Growth (NSFG). In 2010, demographic and sexual behavior correlates were evaluated in bivariate and multivariate analyses by age.HPV vaccine initiation was higher among those aged 15-19 years than those aged 20-24 years (30.3% vs 15.9%, p0.001). No differences existed by race/ethnicity for those aged 15-19 years, but among women aged 20-24 years, non-Hispanic blacks were less likely than non-Hispanic whites to have received the HPV vaccine (AOR=0.15). HPV vaccine initiation was greater for those with insurance regardless of age. HPV vaccination was not associated with being sexually active or number of sex partners at either age. Among sexually active adolescents aged 15-19 years, those who received HPV vaccine were more likely to always wear a condom (AOR=3.0).This study highlights disparities in HPV vaccine initiation by insurance status among girls/women aged 15-24 years and by race/ethnicity among women aged19 years. No association was found between HPV vaccination and risky sexual behavior.

Background: Although the Internet is one of the most commonly accessed resources for health information, finding information on local sexual health services, such as sexually transmitted disease (STD) testing, can be challenging. Recognizing that most quests for online health information begin with search engines, the purpose of this exploratory study was to examine the extent to which online information about local STD/HIV testing services can be found using Google. Methods: Queries on STD and HIV testing services were executed in Google for 6 geographically unique locations across the United States. The first 3 websites that resulted from each query were coded for the following characteristics: (1) relevancy to the search topic, (2) domain and purpose, (3) rank in Google results, and (4) content. Results: Websites hosted at .com (57.3%), .org (25.7%), and .gov (10.5%) domains were retrieved most frequently. Roughly half of all websites (n = 376) provided information relevant to the query, and about three-quarters (77.0%) of all queries yielded at least 1 relevant website within the first 3 results. Searches for larger cities were more likely to yield relevant results compared with smaller cities (odds ratio [OR] = 10.0, 95% confidence interval [CI] = 5.6, 17.9). On comparison with .com domains, .gov (OR = 2.9, 95% CI = 1.4, 5.6) and .org domains (OR = 2.9, 95% CI = 1.7, 4.8) were more likely to provide information of the location to get tested. Discussion: Ease of online access to information about sexual health services varies by search topic and locale. Sexual health service providers must optimize their website placement so as to reach a greater proportion of the sexually active population who use web search engines.

Background We assessed human papillomavirus (HPV) vaccine uptake among adolescent girls, parents’ intentions to vaccinate daughters, and barriers and facilitators of vaccination in a population at elevated risk for cervical cancer. Methods Between October 2007 and June 2008, telephone surveys were conducted with randomly selected parents/guardians of 11–18 year old girls attending public middle and high schools serving economically disadvantaged populations in Los Angeles County. Results We surveyed 509 predominantly Hispanic (81%) and African American (16%) parents; 71% responded in Spanish. Overall, 23% reported their daughter had received ≥1 dose of HPV vaccine. Although 93% of daughters had seen a doctor in the past year, only 30% reported that a provider recommended HPV vaccine. Characteristics positively associated with odds of having initiated HPV vaccine were having heard of the vaccine (adjusted odds ratio [aOR] 2.6), belief in vaccine effectiveness (aOR 2.9), and doctor recommendation (aOR 48.5). Negative attitudes toward HPV vaccine (aOR 0.2) and needing more information about it (aOR 0.1) were negatively associated with vaccine initiation. Of those with unvaccinated daughters ( n = 387), 62% said they “probably/definitely will” vaccinate within the next year and 21% were undecided or didn’t know; only 11% said they definitely won’t. Conclusions About one-quarter of adolescent girls in this at-risk community had initiated HPV vaccine by mid-2008. Provider recommendation was the single most important factor associated with vaccination. Because a substantial proportion of parents remain undecided about HPV vaccine, health care providers can play a key role by providing needed information and offering HPV vaccine to all eligible adolescents.

Background:Human papillomavirus (HPV) vaccine uptake is low among adolescent girls in the United States. We sought to identify longitudinal predictors of HPV vaccine initiation in populations at elevated risk for cervical cancer.Methods:We interviewed a population-based sample of parents of 10- to 1

Background: Most research focusing on marital status and sexual risk has compared married and single midadult women without differentiating single women by their ever married status. We elucidate differences in sexual risk among divorced and never married women. Methods: Data from the National Survey of Family Growth (NSFG) (n = 5,081) were analyzed to compare divorced and never married women in terms of recent and lifetime sex partners, condom use at last vaginal sex, and other sexual risk behaviors. Results: Overall, 13.1% of the women were currently divorced or separated, 62.1% were currently married, 8.3% were cohabitating, and 16.4% were never married. Divorced/separated women were more likely to report 5 or more lifetime sex partners and 2 or more sex partners in the past year than never married women. They were less likely to report condom use. Conclusions: Current findings expose sexual behavioral discrepancies within the single category of women and the need to redefine risk groups for s...

Objective: This review synthesizes findings from the peer-reviewed evaluation literature on condom availability programs (CAPs) in secondary schools. Data Source: Peer-reviewed evaluation literature indexed in MEDLINE, EMBASE, PsychINFO, ERIC, CINAHL, Sociological Abstracts, SCOPUS, and POPLINE. Study Inclusion and Exclusion Criteria: Manuscripts had to be, written in English, and report evaluation data from a US school-based CAP. Data Extraction: Articles were coded independently by 2 authors. Discrepancies were resolved through open discussion. Data Synthesis: We grouped findings into outcome evaluation and process evaluation findings. Outcome evaluation findings included sexually transmitted infections (STIs), pregnancy rates, condom use, contraception use, sexual risk, and substance use. Process evaluation findings included awareness of CAPs, attitudes toward CAPs, attitudes toward condoms, and receipt of education and instruction. Results: Of the 138 citations reviewed, 12 articles published between 1995 and 2012 met the inclusion criteria, representing 8 programs. Evaluations indicate CAPs yield condom acquisition rates between 23% and 48%, have mixed results related to condom use, and are not associated with increases in sexual and other risk behaviors. One program found CAPs were associated with a decrease in a combined rate of chlamydia and gonorrhea. One program found no association between CAPs and unintended pregnancy. Students’ attitudes toward CAPs were favorable and awareness was high. Conclusions: Condom availability programs are accepted by students and can be an appropriate and relevant school-based intervention for teens. Condom availability programs can increase condom use, but more evaluations are needed on CAP impact on rates of HIV, STIs, and unintended pregnancy.

Background: Differential access to basic health information may contribute to persistent cervical cancer disparities. We examined whether human papillomavirus (HPV) vaccine awareness, HPV knowledge, and use of information sources about the vaccine differ by sociodemographic characteristics associated with cervical cancer. Methods: Study participants (n = 889) were caregivers of adolescent girls ages 10 to 18 years living in southeastern North Carolina. Analyses simultaneously controlled for caregivers' gender, race, age, education, income, and rural residence. Results: Although most caregivers were aware of HPV (83%) and the HPV vaccine (82%), awareness differed by gender, race, education, and income. The largest differences were for race, with 87% of Whites versus 68% of African Americans having heard of the vaccine (P < 0.001). Caregivers correctly answered an average of 69% of questions on HPV, with differences by race and education. Most respondents heard of the HPV vaccine through drug company advertisements (83%) or broadcast media coverage (69%). African Americans were less likely than Whites to have heard about the vaccine from advertisements but more likely from a broadcast source (P < 0.05). Health care providers (88%) and the internet (65%) were the most favored sources for future information about the vaccine. Vaccine uptake was associated with awareness, knowledge, and media use. Discussion: Whereas drug company advertisements seem to play a central role in high HPV vaccine awareness, doctors and the internet are the preferred future “go to” sources for seeking out information. Communication-based interventions for caregivers from cervical cancer risk groups, especially African Americans, may need to use different communication channels and content. (Cancer Epidemiol Biomarkers Prev 2009;18(2):363–72)

Objectives. We compared Black West Indian immigrants' and US-born Blacks' sexual and drug-use risk behaviors and their beliefs related to using condoms and informing partners of sexually transmitted infections (STIs) to identify possible differences in risk. Methods. We drew data from the baseline assessment of a clinic-based intervention designed to increase partner STI notification. Results. Black West Indian men were less likely than were US-born Black men to report nonregular partners. There were no differences in condom use. US-born Black women were more likely than were Black West Indian women to be extremely confident that they could convince their regular partners to use condoms (odds ratio [OR] = 2.40; 95% confidence interval [CI] = 1.21, 4.76), whereas there were no differences between Black West Indian and US-born Black men on this measure (interaction P = .06). US-born Black women were more likely than were Black West Indian women to be extremely confident in their ability to discuss STI screening with their regular partners (OR = 1.89; 95% CI = 1.03, 3.47). Conclusions. Black West Indian women's lower levels of confidence that they can discuss STI screening with their regular partners and convince these partners to use condoms may increase their infection risk. Gender-sensitive interventions are warranted for Black West Indian immigrants, especially women.

The current study sought to add to the stress and coping literature by examining whether coping responses are elicited from a diagnosis of chlamydia or gonorrhea and, if so, whether active or passive coping responses are associated with particular psychological factors and prevention behaviors. Data from 259 urban, minority participants recently diagnosed with chlamydia or gonorrhea were analyzed. Results indicated that denial was associated with having more baseline depressive symptoms and with having more one-time partners at follow-up. Problem-focused coping was associated with more consistent condom use at follow-up. Important sex and ethnicity differences were found. Intervention implications are discussed.

Purpose Potential barriers to widespread vaccination of adolescent girls against human papillomavirus (HPV) infection are poorly understood. We provide an overview of potential barriers to provision of HPV vaccine and empirical data on the concerns of medical practices that may inhibit HPV vaccine provision. Method We conducted phone interviews with medical practices in rural areas in southeastern North Carolina with high rates of cervical cancer to assess 10 potential concerns about HPV vaccine provision. Results Concerns most commonly reported by medical practices (N = 71) were inadequate reimbursement (68%), high cost of the vaccine to patients (66%), and burden of determining insurance coverage (66%). Practices that were not providing the vaccine reported more concerns about HPV vaccine provision on average than practices providing the vaccine (6.0 vs. 4.5 concerns, p Conclusions Medical practices' concerns about the HPV vaccine may be barriers to stocking it and, thus, to providing it to adolescents. Even providers who stock the vaccine reported concerns. Research is needed to address ways to ameliorate these medical practices' concerns and also to understand other potential barriers to vaccine coverage.

Heterosexual anal and oral sex are related to the acquisition of sexually transmitted infections, including human immunodeficiency virus infection. We examined the correlates of heterosexual anal and oral sex in the general population, using data from the National Survey of Family Growth.The sample included 12,571 men and women aged 15-44 years (79% response rate).One-third of men and women had ever had anal sex, and three-quarters had ever had oral sex. Condom use during last oral or anal sex was relatively uncommon. In separate models for men and women, having ever had anal sex was associated with white race, age of 20-44 years, and having had a non-monogamous sex partner. White race, age of 20-44 years, being married, and having higher numbers of lifetime sex partners were related to having ever given oral sex in men and women. Giving oral sex was associated with having a non-monogamous sex partner in men. Ever receiving oral sex was associated with white race and a non-monogamous sex partner in men and women.It would be beneficial to track the prevalence of heterosexual anal and oral sex and associated condom use on a more frequent basis.

Objective: The Hurricane Katrina disaster caused rapid displacement of over a million persons in metropolitan New Orleans. The purpose of this study was to describe changes in sexual behavior and access to reproductive care pre- and postrapid displacement among a cohort of young women receiving family planning services before displacement. Methods: Women 16 to 24 years old, who were attending 2 public family planning clinics and enrolled in a vaginal douching prevention study, were located 5 to 6 months after Katrina and interviewed by telephone to elicit information about sexual behavior and access to reproductive care. Results: Women who were located were interviewed (N = 55). Of these, 96% were black, 62% were employed before the disaster, and the mean age was 22.1 (SD 2.1). In the 5 to 6 months after disaster, 86% lived in 3 or more places, 31% had returned to New Orleans, 17% needed health care but could not access it, 40% had not used birth control, and 2 (4%) experienced an unintended pregnancy as a result of lack of access to care. When compared with baseline, after the hurricane, women were less likely to have attended family planning services, to have used birth control, to have >1 sex partner, to have a vaginal odor or discharge. Conclusion: Relief efforts for disasters causing rapid displacement of impoverished women should include reproductive care such as provision of contraception, condoms, and STI services, as well as linking women back into care.

The highest rates of sexually transmitted infections in the U.S. occur among adolescent females. One prevention strategy promoted for sexually active adolescents is condom use: therefore, influences on correct and consistent condom use are worth examining. Because interventions and observational research into predicting and increasing condom use have yielded mixed results, we hypothesized that a theoretically driven model incorporating female adolescents' perceptions about partner sentiments along with their own perceptions, intentions, and behaviours would improve condom use predictions. We also measured condom use errors and consistency for a more precise estimate of effective use than is common in the literature. In three structural equation models tested on a sample of 519 female adolescents, we found that intentions were associated with both correct and consistent condom use; that females' expectancy beliefs about condom use were associated with intentions; and that females' expectancy beliefs about partners' sentiments reduced the impact of their expectancy beliefs about condom use. The implications of these relations upon condom use correctness and consistency are discussed with respect to informing interventions, among other future research.

In this chapter we identify psychosocial issues that have been raised with respect to human papillomavirus (HPV) vaccination and review the research literature on HPV vaccine acceptability. Many women and physicians have relatively poor knowledge about HPV, but despite this, most healthcare providers are willing to recommend HPV vaccination and parents are interested in having their children vaccinated. Concerns about post-vaccination sexual behavior change do not appear to be justified, but can certainly be addressed through anticipatory guidance. Most research studies have come out of the United States and other English-speaking industrialized countries. More psychosocial research regarding HPV vaccination is therefore needed from developing countries.

Efforts to control chlamydial and gonococcal infections include notifying eligible sexual partners of possible infection, primarily by asking the diagnosed patient to notify their partners. This approach, known as patient referral, is widely used but poorly understood. The current study examined psychosocial and cognitive factors associated with patient referral among an urban, minority sample of 168 participants recently diagnosed with Chlamydia trachomatis or Neisseria gonorrhoeae. At a follow-up interview 1-month from diagnosis, participants were more likely to have notified all eligible partners if they had greater intention to notify at baseline (OR = 3.72; 95% CI = 1.34, 10.30) and if they had only one partner at baseline (OR = 4.08; 95% CI = 1.61, 10.31). There were also gender differences as well as differences based on type of partner (i.e., regular, casual, one-time). The implications of these findings for the design of programs to promote patient referral for sexually transmitted infections are discussed.

Purpose To describe parents’ acceptance of a hypothetical herpes simplex virus type 2 (HSV-2) vaccine, attitudes toward vaccine legislation, beliefs regarding appropriate timing of vaccination and correlates of vaccine acceptance. Methods A telephone survey of 315 parents/guardians in the Southeast United States. Descriptive statistics describe the sample’s overall attitudes toward HSV-2 vaccination, vaccine legislation, and age preferences. A logistic regression model tested the correlates of intention to vaccinate their children against HSV-2. Results A majority of parents (69%) said they would have their children vaccinated. Nearly one-third (29.3%) thought genital herpes vaccination should take place between the ages of 11 and 13 years. Logistic regression revealed that females, single parents, parents whose children had influenza shots, those with more favorable attitudes to vaccination in general, and those who believed sexually transmitted disease (STD) vaccines would be beneficial were more likely to state they would vaccinate their children. Conclusions Overall, a large proportion of parents indicated they would accept HSV-2 vaccination for their children. These results help identify those parents who may or may not be open to vaccinating their children against HSV-2 and inform future interventions to encourage HSV-2 vaccination. This research highlights the need for interventions that differentially target those who would and would not be likely to support vaccination of their children. Results also indicate that many parents believe vaccination should be given after an age when many adolescents have initiated sexual activity. Interventions to promote STD vaccines should not only encourage vaccination, but should also seek to change parental attitudes about optimal timing of the vaccination.

Purpose Despite official recommendation for routine HPV vaccination of boys and girls at age 11–12 years, parents and providers are more likely to vaccinate their children/patients at older ages. Preferences for vaccinating older adolescents may be related to beliefs about an adolescent's sexual experience or perceived parental resistance to vaccinating children who are assumed to be sexually inexperienced. Methods Using data from the 1995 wave of the National Longitudinal Study of Adolescent Health (ADD Health), a subset of a nationally representative sample of adolescents in grades 7 through 12 and their parents (n = 13,461), we investigated maternal underestimation of adolescent sexual experience. Results About one third (34.8%) of adolescents reported being sexually experienced and of these, 46.8% of their mothers inaccurately reported that their child was not sexually experienced. Underestimation varied by adolescent age with 78.1% of mothers of sexually active 11–13-year-olds reporting their child was not sexually active, compared with 56.4% of mothers of sexually active 14–16-year-olds and only 34.4% of mothers of 17–18-year-olds. Conclusions Although most adolescents are not sexually active at age 11 or 12 years, waiting until a parent thinks a child is sexually active could result in missed opportunities for prevention.

Importance Since licensure of the human papillomavirus (HPV) vaccine in 2006, HPV vaccine coverage among US adolescents has increased but remains low compared with other recommended vaccines. Objective To systematically review the literature on barriers to HPV vaccination among US adolescents to inform future efforts to increase HPV vaccine coverage. Evidence Review We searched PubMed and previous review articles to identify original research articles describing barriers to HPV vaccine initiation and completion among US adolescents. Only articles reporting data collected in 2009 or later were included. Findings from 55 relevant articles were summarized by target populations: health care professionals, parents, underserved and disadvantaged populations, and males. Findings Health care professionals cited financial concerns and parental attitudes and concerns as barriers to providing the HPV vaccine to patients. Parents often reported needing more information before vaccinating their children. Concerns about the vaccine’s effect on sexual behavior, low perceived risk of HPV infection, social influences, irregular preventive care, and vaccine cost were also identified as potential barriers among parents. Some parents of sons reported not vaccinating their sons because of the perceived lack of direct benefit. Parents consistently cited health care professional recommendations as one of the most important factors in their decision to vaccinate their children. Conclusions and Relevance Continued efforts are needed to ensure that health care professionals and parents understand the importance of vaccinating adolescents before they become sexually active. Health care professionals may benefit from guidance on communicating HPV recommendations to patients and parents. Further efforts are also needed to reduce missed opportunities for HPV vaccination when adolescents interface with the health care system. Efforts to increase uptake should take into account the specific needs of subgroups within the population. Efforts that address system-level barriers to vaccination may help to increase overall HPV vaccine uptake.

Objectives: To identify the prevalence and correlates of engaging in unprotected sex while experiencing symptoms of gonorrhea among a sample of men with a laboratory confirmed diagnosis. Methods: Cross-sectional interview data were analyzed from 237 men reporting dysuria or discharge with a laboratory- confirmed diagnosis of gonorrhea. Results: A total of 21.1% reported engaging in unprotected sex while having symptoms. In multivariate analyses men engaging in sex >/=5 times in the past 30 days were 3.5 times more likely to report unprotected sex while symptomatic (P = 0.001). Men reporting condom use

Importance Long-acting reversible contraception (LARC), specifically intrauterine devices and implants, offers an unprecedented opportunity to reduce unintended pregnancies among adolescents because it is highly effective even with typical use. However, adolescent LARC users may be less likely to use condoms for preventing sexually transmitted infections compared with users of moderately effective contraceptive methods (ie, oral, Depo-Provera injection, patch, and ring contraceptives). Objective To compare condom use between sexually active female LARC users and users of moderately effective contraceptive methods. Design, Setting, and Participants Cross-sectional analysis using data from the 2013 national Youth Risk Behavior Survey, a nationally representative sample of US high school students in grades 9 through 12. Descriptive analyses were conducted among sexually active female students (n = 2288); logistic regression analyses were restricted to sexually active female users of LARC and moderately effective contraception (n = 619). The analyses were conducted in July and August 2015. Main Outcomes and Measures Contraceptive method at last sexual intercourse was assessed by 1 item—respondents could select birth control pills; condoms; an intrauterine device or implant; injection, patch, or ring; withdrawal or other method; or not sure. A separate item asked whether respondents used a condom at last sexual intercourse. We created an indicator variable to distinguish those reporting use of (1) LARC (intrauterine device or implant), (2) oral contraceptives, and (3) Depo-Provera, patch, or ring. Results Among the 2288 sexually active female participants (56.7% white; 33.6% in 12th grade), 1.8% used LARC; 5.7% used Depo-Provera, patch, or ring; 22.4% used oral contraceptives; 40.8% used condoms; 11.8% used withdrawal or other method; 15.7% used no contraceptive method; and 1.9% were not sure. In adjusted analyses, LARC users were about 60% less likely to use condoms compared with oral contraceptive users (adjusted prevalence ratio [aPR], 0.42; 95% CI, 0.21-0.84). No significant differences in condom use were observed between LARC users and Depo-Provera injection, patch, or ring users (aPR, 0.57; 95% CI, 0.26-1.25). The LARC users were more than twice as likely to have 2 or more recent sexual partners compared with oral contraceptive users (aPR, 2.61; 95% CI, 1.75-3.90) and Depo-Provera, patch, or ring users (aPR, 2.58; 95% CI, 1.17-5.67). Conclusions and Relevance Observed differences in condom use may reflect motivations to use condoms for backup pregnancy prevention. Users of highly effective LARC methods may no longer perceive a need for condoms even if they have multiple sexual partners, which places them at risk for sexually transmitted infections. As uptake of LARC increases among adolescents, a clear need exists to incorporate messages about condom use specifically for sexually transmitted infection prevention.