Eric R. Walsh-Buhi

Assessing Relationship and Sexual Satisfaction in Adolescent Relationships Formed Online and Offline.

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.

An Integrative Theoretical Framework for HPV Vaccine Promotion Among Male Sexual Minorities

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.

Rural and Urban Differences in Sexual Behaviors Among Adolescents in Florida

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.

Factors Influencing College Women's Contraceptive Behavior: An Application of the Integrative Model of Behavioral Prediction.

ABSTRACT Objective: 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. Participants: A nonprobability sample of 515 female college students completed an Internet-based survey between November 2014 and February 2015. Methods: Respondents were asked about their contraception use, knowledge and information sources, demographic information, and IMBP factors, including attitudes, norms, and perceived behavioral control (PBC). Results: 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. Conclusions: This study highlights the need to consider where college women acquire contraceptive information which is associated with SES.

Pregnancy prevention at her fingertips: A text- and mobile video–based pilot intervention to promote contraceptive methods among college women

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.

Scalability of an Evidence-Based Adolescent Pregnancy Prevention Program: New Evidence From 5 Cluster-Randomized Evaluations of the Teen Outreach Program.

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.

Okay, We Get It. You Vape: An Analysis of Geocoded Content, Context, and Sentiment regarding E-Cigarettes on Twitter.

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.

Evaluating the Effects of the Teen Outreach Program on Positive Youth Development Constructs

Introduction: The Teen Outreach Program (TOP) is a positive youth development (PYD) program that seeks to reduce the risk of adolescent pregnancy, school dropout, and course failure. As TOP has not been evaluated for its impact on PYD constructs, our purpose was to assess this potential. Methods: A pair-matched, cluster randomized controlled trial to evaluate TOP among youth in 26 high schools was conducted in 2013-2014. Youth (N=3740) were surveyed at baseline and immediately following program completion. A linear mixed effects model compared scores of the Lerner’s Five Cs measure of PYD between treatment and control youth and by race/ethnicity and gender subgroups. Results: After a multiple comparison adjustment, no statistically significant results were observed. Conclusions: Despite the lack of statistically significant findings, the current study can provide insight for future evaluations of TOP regarding adaptation and evaluation of core components, implementation, PYD impacts, and sexual and reproductive health outcomes.

Three Important Lessons From Research About Sexual and Reproductive Health

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.

Preventing Risky Sexual Behavior in Adolescents

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