Eric R. Buhi

An Observational Study of How Young People Search for Online Sexual Health Information

Abstract Little is known about the quality of online sexual health information, how young people access the Internet to answer their sexual health questions, or an individuals ability to sort through myriad sources for accurate information. Objective: The purpose of this study was to determine how college students search for online sexual health information and whether they retrieve accurate answers to sexual health questions. Participants: In fall 2007, the authors recruited 34 first-year, first-semester undergraduates to participate in an observational research study, using Camtasia Studio. Results: Most students found accurate answers to the 12 sexual health questions posed. Finding local information and resources online proved more difficult than finding answers to general sexual health questions. Conclusions: The Internet has become the leading source for sexual health information. Based on their findings, the authors argue that young people must be educated about how Web search engine results are prioritized/displayed and trained to evaluate Web sites for reliable information.

Mobile Phone-Based Behavioural Interventions for Health: A Systematic Review.

Objective: To perform a systematic review of the literature concerning behavioural mobile health (mHealth) and summarize points related to heath topic, use of theory, audience, purpose, design, intervention components, and principal results that can inform future health education applications. Design: A systematic review of the literature. Method: Thirty-four interventions published in peer-reviewed journals before July 2010, employing a short message service (SMS) and/or multimedia message service to address health-related behavioural change, were reviewed. Results: Five interventions utilized SMS alone, 18 employed SMS/Internet, and 11 utilized SMS, Internet, and other strategies. Intervention length ranged from four weeks to one year. Twenty interventions (59%) were evaluated using experimental designs, and most resulted in statistically significant health behavioural changes. Conclusion: Surveillance of mHealth interventions’ role in facilitating behavioural change is a judicious parallel activity for health education and health behaviour authorities.

The State of the Union: Sexual Health Disparities in a National Sample of US College Students

Abstract Objective: To examine sexual health disparities between blacks and whites in a national sample of US college students. Participants and Method Summary: Analyses utilized secondary data from 44,165 nonmarried undergraduates (aged 18–24; M = 20.1) responding to the Spring 2007 American College Health Association–National College Health Assessment; 64% were female and 94.7% were white. Results: Whites reported more experience in oral and anal sex, were less likely to use condoms for oral, anal, and vaginal sex, and less likely to have been tested for HIV (human immunodeficiency virus) compared with blacks. However, blacks reported more sex partners, lower use of hormonal contraceptives, and higher rates of adverse sexual health outcomes, such as sexually transmitted infections (STIs) and unintended pregnancy. Sexual behaviors and outcomes also varied across gender. Conclusions: This study highlights a need to increase access to hormonal contraceptives and early STI screening/treatment among blacks, improve HIV testing among whites, and increase condom use promotion for all students.

Stalking Victimization Among College Women and Subsequent Help-Seeking Behaviors

Objective: The authors examined the incidence of stalking victimization and subsequent help-seeking behaviors among college women. Participants and Methods: A stratified random sample of college women (N = 391) completed an anonymous Internet-based questionnaire in spring 2006. Results: One-fifth of women reported stalking victimization while enrolled at their current institution. Individuals known by victims, such as the following, were most commonly reported as stalkers: acquaintances (48.7%), classmates (37.2%), and boyfriends or ex-boyfriends (34.6%). Approximately half of the women reporting stalking victimization acknowledged not seeking help from anyone in relation to these incidents. Of those seeking some sort of help, most sought assistance from friends (90.2%), parents (29.3%), residence hall advisors (12.2%), or police (7.3%). Conclusion: Comparing their findings to a national study of college women, the authors report that being watched, followed or spied on, and sent unsolicited emails are stalking behaviors on the rise. They present implications for college health and future directions for research.

Influences on Human Papillomavirus Vaccination Status Among Female College Students

OBJECTIVE In 2006, the Food and Drug Administration (FDA) approved the human papillomavirus (HPV) vaccine Gardasil® (Merck) for girls and women aged 9-26 years. Although the vaccine is ideally administered to 11 and 12 year olds, college-aged women may be uniquely at risk for HPV due to high rates of sexual activity and, thus, serve as an important catch-up population for the HPV vaccine. The purpose of this study is to examine factors associated with HPV vaccination status among college women. METHODS In fall 2008, a convenience sample of 256 undergraduate women enrolled in an introductory social science course at a large, public, urban university in the southeastern United States was surveyed. The 30-item paper-and-pencil questionnaire asked for demographic information, HPV knowledge, HPV vaccine beliefs, and HPV vaccination status. The overall survey response rate was 89.6%. RESULTS Most women were unmarried/single (91.7%), with a mean age of 18.9 years (range 17-42). Race/ethnicity status included 73.0% white, 17.5% Hispanic, and 7.7% black/African American. One hundred eleven (40.5%) women reported receiving the vaccine. Nonvaccinated women were less likely to have heard of the vaccine through a healthcare provider (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.04-0.35) or from a family member (OR 0.33, 95% CI 0.16-0.68) and more likely to consider a healthcare provider recommendation as being only somewhat important (OR 2.91, 95% CI 1.32-6.41) or not important at all (OR 5.61, 95% CI 0.44-71.87) vs. very important. CONCLUSIONS Findings suggest that healthcare providers have an important role in encouraging HPV vaccination. Continuing education for providers who see preadolescent girls in conjunction with a parent or who treat women of college age may be a worthwhile endeavor.

Quality and Accuracy of Sexual Health Information Web Sites Visited by Young People

We assessed online sexual health information quality and accuracy and the utility of web site quality indicators. In reviewing 177 sexual health web sites, we found below average quality but few inaccuracies. Web sites with the most technically complex information and/or controversial topics contained the most inaccuracies. We found no association between inaccurate information and web site quality.

Health beliefs and attitudes associated with HPV vaccine intention among young gay and bisexual men in the southeastern United States

Gay and bisexual men are at increased risk of anal cancer as a result of human papillomavirus (HPV) infection. Prophylactic vaccination is a potentially effective strategy for preventing anal cancer in this population. The purpose of this study was to identify factors associated with gay and bisexual mens intention to receive HPV vaccine. In the fall of 2010, 179 self-identified gay and bisexual men (mean age 22 years) completed an Internet-based questionnaire assessing beliefs and attitudes toward HPV vaccination. Men were recruited from college-based and Internet venues throughout the southeastern United States. The probability of intent to receive HPV vaccine was modeled using logistic regression. A majority of men (93%) had heard of HPV prior to participation but were generally unaware of the association of HPV with anal, penile, and oral cancers. Only 26% were aware of an HPV vaccine for males. Of the 179 participants, 64 (36%) were likely to be vaccinated. Men most likely to receive HPV vaccine perceived stronger physical and psychological benefits from vaccination and had more positive attitudes toward the vaccine. Conversely, intent to be vaccinated was negatively associated with concern over the financial cost of vaccination. Findings from this study can inform college-based health education programs aimed at increasing vaccine uptake among gay and bisexual men.

Ethnic and Racial Differences in HPV Knowledge and Vaccine Intentions among Men Receiving HPV Test Results

We examined factors associated with HPV vaccine intentions by racial/ethnic group among men participating in a HPV natural history study. HPV knowledge, vaccine intentions and perceived barriers were assessed among non-Hispanic White, non-Hispanic Black and Hispanic men. Men were tested for HPV every 6 months. After receiving test results from their previous visit, participants (N=477) reported their intentions for HPV vaccination in a computer-assisted survey instrument (CASI). Vaccine intentions were high among all respondents, although differences were found between racial and ethnic groups in awareness and knowledge of HPV and, vaccine intentions and perceived access and barriers to receiving the HPV vaccine. In order to effectively disseminate the vaccine among men, factors that may promote or inhibit vaccine acceptability need to be identified. Identifying these factors related to vaccine intentions among minority and majority men offers an opportunity for addressing barriers to health equity and, in turn, reductions in HPV-related disparities.

Adolescent Sexual Abstinence: A Test of an Integrative Theoretical Framework

The purpose of this study was to test an integrative theoretical framework in explaining adolescents’ sexual abstinence and intentions to remain abstinent and refine the framework to reflect which elements contribute more powerfully to the explanation of abstinence and intentions. We administered an anonymous, theory-based questionnaire to two nonrandom samples of seventh- and eighth-graders (n = 451 and 447, respectively). Measurement modeling provided sufficient evidence for establishing construct validity. A refined structural equation model demonstrated good fit. Pro-abstinence standards predicted stronger beliefs toward staying abstinent, stronger perceptions that others endorse pro-abstinence norms, and a greater self-efficacy to remain sexually abstinent until marriage. In turn, beliefs, norms, and self-efficacy were predictive of intentions, which predicted sexual abstinence at a later time point. Similar findings emerged in a replication using a second set of sample data. Results suggest that this integrative theoretical framework is useful in explaining adolescents’ intention and their subsequent sexual abstinence.

Evaluating the Internet as a sexually transmitted disease risk environment for teens: findings from the communication, health, and teens study.

Background Few studies have examined the association between sexual health risks and online sex-seeking among teenagers. The purpose of this study was to assess the associations between meeting sex partners online and a range of sexual risk behaviors and outcomes among adolescents. Methods Participants aged 13 to 19 years were recruited from a publicly funded teen clinic in Florida. After obtaining informed consent/assent, 273 participants completed an audio computer-assisted self-interview that included questions on demographics, sexual behavior, sexually transmitted disease (STD) history, and online sex-seeking behaviors and experiences. Participants also provided urine samples for chlamydia and gonorrhea testing. Data were analyzed using logistic regression to identify the association between having an online sex partner and sexual behaviors/outcomes. Results After adjusting for significant bivariate correlates, teens reporting online sex partners were more likely to be male, be multiracial, have a history of same-sex sexual activity, report a higher number of vaginal sex partners, and report a lower age at first vaginal sex. However, teens with online sex partners were no more likely to have ever had an STD or a current biological STD. Conclusions This study is one of the first to correlate biological STD results to online sexual partnering data in a youth population. Although meeting a sex partner online was not associated with past or current STDs, it was associated with other sexual risk behaviors. Future research is needed to examine the complex nature of online sexual partnering among adolescents and to develop intervention approaches.