Jessica L. Barnack-Tavlaris

Sexual Health Discussions with Older Adult Patients During Periodic Health Exams

INTRODUCTION Sexual health is an integral part of overall health across the lifespan. In order to address sexual health issues, such as sexually transmitted infections (STIs) and sexual functioning, the sexual history of adult patients should be incorporated as a routine part of the medical history throughout life. Physicians and health-care professionals cite many barriers to attending to and assessing the sexual health needs of older adult patients, underscoring the importance of additional research to improve sexual history taking among older patients. AIM The purpose of this article is to explore the content and context of physician-patient sexual health discussions during periodic health exams (PHEs) with adults aged 50-80 years. METHODS Patients completed a pre-visit telephone survey and attended a scheduled PHE with their permission to audio-record the exam. Transcribed audio recordings of 483 PHEs were analyzed according to the principles of qualitative content analysis. MAIN OUTCOME MEASURES Frequency of sexual history taking components as observed in transcripts of PHEs. Physician characteristics were obtained from health system records and patient characteristics were obtained from the pre-visit survey. RESULTS Analyses revealed that approximately one-half of the PHEs included some discussion about sexual health, with the majority of those conversations initiated by physicians. A two-level logistic regression model revealed that patient-physician gender concordance, race discordance, and increasing physician age were significantly associated with sexual health discussions. CONCLUSION Interventions should focus on increasing physician self-efficacy for assessing sexual health in gender discordant and race/ethnicity concordant patient interactions. Interventions for older adults should increase education about sexual health and sexual risk behaviors, as well as empower individuals to seek information from their health-care providers.

A Comparison of Actual and Perceived Sexual Risk Among Older Adults

Sexual risk among older adults (OAs) is prevalent, though little is known about the accuracy of sexual risk perceptions. Thus, the aim was to determine the accuracy of sexual risk perceptions among OAs by examining concordance between self-reported sexual risk behaviors and perceived risk. Data on OAs aged 50 to 92 were collected via Amazon.com’s Mechanical Turk. Frequency of sexual risk behaviors (past six months) were reported along with perceived risk, namely, sexually transmitted infection (STI) susceptibility. Accuracy categories (accurate, underestimated, overestimated) were established based on dis/concordance between risk levels (low, moderate, high) and perceived risk (not susceptible, somewhat susceptible, very susceptible). Approximately half of the sample reported engaging in vaginal (49%) and/or oral sex (43%) without a condom in the past six months. However, approximately two-thirds of the sample indicated they were “not susceptible” to STIs. No relationship was found between risk behaviors and risk perceptions, and approximately half (48.1%) of OAs in the sample underestimated their risk. Accuracy was found to decrease as sexual risk level increased, with 93.1% of high-risk OAs underestimating their risk. Several sexual risk behaviors are prevalent among OAs, particularly men. However, perception of risk is often inaccurate and warrants attention.

Human Papillomavirus Vaccination Awareness and Acceptability Among U.S.-Born and U.S. Foreign-Born Women Living in California.

We examined human papillomavirus vaccine awareness and acceptance between U.S.-born and U.S. foreign-born women by utilizing California Health Interview Survey data from 1,672 women (ages 18–27) and 2,994 mothers (ages 28–65). Foreign-born women and mothers had lower vaccine awareness. Foreign-born young adult Latinas had greater vaccine acceptance than U.S.-born Latinas. Other factors associated with young adult womens vaccine acceptability were being younger, unmarried, and sexually active in the past year; having poorer self-reported health; and having heard of the vaccine. Variables associated with mothers’ vaccine acceptability were being White, insured, and unmarried; having had a Pap test in past 3 years; being less educated; and being impoverished.

Young Women's Sexual and Reproductive Health Post HPV Vaccination

In the present study the authors sought to explore, in greater depth, the impact that HPV vaccination has on college-aged womens reproductive and sexual health. Qualitative interviews were conducted with 30 HPV-vaccinated, college women and analyzed for reoccurring themes. Although findings revealed that womens HPV-related knowledge was suboptimal, most women correctly believed that they were still at risk for HPV after having received the vaccination. Women indicated that having the HPV vaccine made them more aware of sexually transmitted infections and prompted them to continue to take care of their sexual health. Women reported that having the HPV vaccine did not influence their condom use or birth control choices, and they believed that obtaining Pap smears was still important. These results help us to understand the impact of HPV vaccination on womens reproductive and sexual health. These findings are promising and reinforce the importance of educating women about behaviors that will help them maintain reproductive and sexually healthy lives.

Focus Group Discussions in Community-Based Participatory Research to Inform the Development of a Human Papillomavirus (HPV) Educational Intervention for Latinas in San Diego

The purpose of this paper is to demonstrate the usefulness of formative focus groups as a community-based participatory research (CBPR) method in developing cancer education programs. Two focus groups were conducted according to CBPR principles, in order to develop a community-competent human papillomavirus (HPV)/cervical cancer educational program for Latinas living in the USA/Mexico border region. Focus group participants were 18 female Mexican American community health advisors. Participants reported that there is limited information and many myths about HPV and the vaccine in the Latino/Latina community, along with many barriers to acceptance of HPV/cervical cancer-related information. Furthermore, participants discussed their recommendations for the development of a culturally appropriate HPV educational program. From these data, we have a better understanding of the HPV/cervical cancer educational approach that will be most accepted in the community and what key information needs to be provided to women who participate in the program, which reinforces the importance of the CBPR approach to the formative phase of cancer education program development.

I have human papillomavirus: An analysis of illness narratives from the Experience Project

PURPOSE Human papillomavirus (HPV) is the most common sexually transmitted virus worldwide. Our purpose was to examine peoples experiences with HPV using narratives posted on a website entitled, Experience Project. METHOD We conducted a content analysis of 127 HPV narratives to identify stigma, emotion-focused and problem-focused coping, and misinformation. RESULTS Negative self-image was the most commonly identified type of stigma. There were more instances of problem-focused than emotion-focused coping. Sources of confusion were mostly about HPV treatment and side effects/symptoms. CONCLUSIONS These findings have implications for how nurses and other health professionals can care for individuals living with HPV. Based on these findings, it would be beneficial for clinics/providers to implement on-line forums where myths about HPV can be debunked and accurate information provided. Both patients and the public need to be better informed about HPV, in order to decrease the negative stigma that can create a mental burden for individuals with HPV.