Jessie Ford

An Assessment of the GYT: Get Yourself Tested Campaignc An Integrated Approach to Sexually Transmitted Disease Prevention Communication

Background Youth in the United States bear a disproportionate burden of sexually transmitted diseases (STDs). Stigma, misconceptions, and access challenges keep many from getting tested or treated. The GYT: Get Yourself Tested campaign was launched in 2009 to reduce stigma and promote STD communication and testing. This evaluation sought to assess the first 2 years of campaign engagement and associations with STD testing among youth. Methods Campaign engagement with select GYT on-the-ground events, social media sites, and STD testing locator tools was measured through process/media tracking metrics. Sexually transmitted disease testing patterns were assessed using data from Planned Parenthood affiliates (2008–2010) and national trend data from clinics participating in national infertility prevention activities (2003–2010). Results On-the-ground events reached an estimated 20,000 youth in 2009 and 52,000 youth in 2010. Across 2009 to 2010, GYT’s Facebook page gained 4477 fans, Twitter feed gained 1994 followers, and more than 140,000 referrals were made to the STD testing locator. From April 2008 to 2010, there was a 71% increase in STD testing and a 41% increase in chlamydia testing at reporting Planned Parenthood affiliates (representing ∼118 health centers). Chlamydia case positivity rates during this period were stable at 6.6% (2008) and 7.3% (2010). Trend data indicate that testing was higher in spring 2009 and 2010 compared with other periods during those years; this pattern is commensurate with STD Awareness Month/GYT activities. Conclusions Data quality is limited in a manner similar to many STD prevention efforts. Within these limitations, evidence suggests that GYT reaches youth and is associated with increased STD testing.

Primary Cesarean Delivery Among Parous Women in the United States, 1990 – 2003

OBJECTIVE: To explore trends in primary cesarean delivery rates among parous women with singleton pregnancies in the United States between 1990 and 2003. METHODS: The analysis used data from national birth files based on U.S. birth certificates between 1990 and 2003. The primary cesarean delivery rate was defined as the number of primary cesarean deliveries per 100 deliveries among parous women with singleton pregnancies who have not had a previous cesarean delivery. A stratified analysis was employed to investigate whether trends varied by maternal age, gestational age, race/ethnicity, or region. RESULTS: In the United States, the primary cesarean delivery rate among parous women decreased modestly from 7.1% in 1990 to 6.6% in 1996 but increased progressively to 9.3% in 2003. The increase in cesarean rates from 1996 to 2003 varied substantially by race/ethnicity: Hispanic and non-Hispanic white women exhibited lower and similar rates, whereas rates for non-Hispanic black women were consistently higher and rose by a far greater extent across the years. There were substantial differences in cesarean delivery trends across geographic divisions, with greatest increases observed in the mid-Atlantic, South Central, and South Atlantic areas of the United States. Primary cesarean rates also declined considerably with increasing gestational age. CONCLUSION: Similar to the overall cesarean delivery rate, primary cesarean rates among parous women with singleton pregnancies have increased substantially in the United States since 1996. LEVEL OF EVIDENCE: III

Effects of Interpregnancy Interval on Blood Pressure in Consecutive Pregnancies

The lower risk of preeclampsia observed in parous women has prompted a hypothesis that cardiovascular adaptation from a first pregnancy has ongoing benefits which contribute to a reduced risk of preeclampsia in the second pregnancy. However, how the interpregnancy interval affects mean arterial pressure (MAP) as an indicator of cardiovascular adaptation in subsequent pregnancies has not been well studied. The authors examined the effect of interpregnancy interval on MAP in consecutive pregnancies using data from the Collaborative Perinatal Project (1959-1965) and a semiparametric random-effects regression model. Prenatal MAP measurements were available for 533 women with both first and second births. MAP was lower in the second pregnancy (by approximately 2 mmHg) for very short interpregnancy intervals. However, this difference diminished when the interval increased, and it totally disappeared for intervals longer than 2 years. The authors conclude that although MAP is lower in the second pregnancy than in the first pregnancy, the effect persists for only a short time. It is therefore unlikely that mechanisms involving MAP as an indicator of cardiovascular adaptation contribute appreciably to the reduced risk of preeclampsia in subsequent pregnancies. However, it does not rule out the possibility that other mechanisms of cardiovascular adaptation persist longer.

Student Bodies Does the Sex Ratio Matter for Hooking Up and Having Sex at College

Using the Online College Social Life Survey, we examine whether the sex ratio of the student body of a college or university affects whether heterosexual students hook up, have relationships, have intercourse, or have attitudes favorable toward casual sex. The gendered dyadic power model predicts that, if men are more interested in having sex than women, as the ratio of women to men goes up, men will increasingly have the upper hand and more sex will occur. Consistent with the prediction, we find that where the ratio of women to men is higher, students of both sexes hook up more and accumulate more sexual partners, but inconsistent with it, students are no more likely to have intercourse in a given hookup where the ratio of women is higher.

Preparing for human papillomavirus vaccine introduction in Kenya: implications from focus-group and interview discussions with caregivers and opinion leaders in Western Kenya

BackgroundCervical cancer claims the lives of 275,000 women each year; most of these deaths occur in low-or middle-income countries. In Kenya, cervical cancer is the leading cause of cancer-related mortality among women of reproductive age. Kenya’s Ministry of Public Health and Sanitation has developed a comprehensive strategy to prevent cervical cancer, which includes plans for vaccinating preteen girls against human papillomavirus (HPV) by 2015. To identify HPV vaccine communication and mobilization needs, this research sought to understand HPV vaccine-related perceptions and concerns of male and female caregivers and community leaders in four rural communities of western Kenya.MethodsWe conducted five focus groups with caregivers (n = 56) and 12 key-informant interviews with opinion leaders to explore cervical cancer-related knowledge, attitudes and beliefs, as well as acceptability of HPV vaccination for 9–12 year-old girls. Four researchers independently reviewed the data and developed codes based on questions in interview guides and topics that emerged organically, before comparing and reconciling results through a group consensus process.ResultsCervical cancer was not commonly recognized, though it was understood generally in terms of its symptoms. By association with cancer and genital/reproductive organs, cervical cancer was feared and stigmatized. Overall acceptability of a vaccine that prevents cervical cancer was high, so long as it was endorsed by trusted agencies and communities were sensitized first. Some concerns emerged related to vaccine safety (e.g., impact on fertility), program intent, and health equity.ConclusionFor successful vaccine introduction in Kenya, there is a need for communication and mobilization efforts to raise cervical cancer awareness; prompt demand for vaccination; address health equity concerns and stigma; and minimize potential resistance. Visible endorsement by government leaders and community influencers can provide reassurance of the vaccine’s safety, efficacy and benefits for girls and communities. Involvement of community leadership, parents and champions may also be critical for combatting stigma and making cervical cancer relevant to Kenyan communities. These findings underscore the need for adequate planning and resources for information, education and communication prior to vaccine introduction. Specific recommendations for communication and social-marketing strategies are made.

A Systematic Review of Sexual Health Interventions for Adults: Narrative Evidence

Recent work has explored the intersection between sexual health (as construed by the World Health Organization and others) and public health domains of action in the United States of America. This article reports the narrative results of a systematic review of sexual health intervention effects on public health–relevant outcomes. To qualify, interventions had to be based on the principles (1) that sexual health is intrinsic to individuals and their overall health and (2) that relationships reflecting sexual health must be positive for all parties concerned. Outcomes were classed in domains: knowledge, attitudes, communication, health care use, sexual behavior, and adverse events. We summarized data from 58 studies (English language, adult populations, 1996–2011) by population (adults, parents, sexual minorities, vulnerable populations) across domains. Interventions were predominantly individual and small-group designs that addressed sexual behaviors (72%) and attitudes/norms (55%). They yielded positive effects in that 98% reported a positive finding in at least one domain; 50% also reported null effects. The most consistently positive effects on behaviors and adverse events were found for sexual minorities, vulnerable populations, and parental communication. Whether via direct action or through partnerships, incorporating principles from existing sexual health definitions in public health efforts may help improve sexual health.

Reaching Youth With Sexually Transmitted Disease Testing Building on Successes, Challenges, and Lessons Learned From Local Get Yourself Tested Campaigns

Nine programs were funded across eight states in the United States to customize, implement, and evaluate local campaigns in support of the national Get Yourself Tested (GYT) campaign. Each program promoted chlamydia screening and treatment/referral to sexually active young women (aged 15–25 years) and their partners through accessible, free, or low-cost services. This article documents the strategies and outcomes of these local GYT campaigns, highlighting the diversity in which a national sexual health campaign is implemented at the local level and identifying challenges and successes. Nearly all (n = 7) programs involved target audience members in campaign development/implementation. Youth were linked to free or low-cost sexually transmitted disease testing through community centers, high schools and colleges, community and clinic events; online or text-based ordering of test kits; and community pickup locations. Sites used a combination of traditional and new media, on-the-ground activities, promotional products, and educational and social events to promote testing. With the exception of one site, all sites reported increases in the number of persons tested for chlamydia during campaign implementation, compared to baseline. Increases ranged from 0.5% to 128%. Successes included development of local partnerships, infrastructure, and capacity; use of peer leaders and involvement; and opportunities to explore new innovations. Challenges included use of social media/new technologies, timing constraints, limited organizational and evaluation capacity, and unforeseen delays/setbacks. Each of these issues is explored, along with lessons learned, with intent to inform future sexual health promotion efforts.

Risk of cesarean delivery when second-trimester ultrasound dating disagrees with definite last menstrual period.

Estimates of gestational age based on early second-trimester ultrasound often differ from that based on the last menstrual period (LMP) even when a woman is certain about her LMP. Discrepancies in these gestational age estimates may be associated with an increased risk of cesarean section and low birth weight. We analyzed 7228 singleton, low-risk, white women from The Routine Antenatal Diagnostic Imaging with Ultrasound trial. The women were recruited at less than 14 weeks of gestation and received ultrasound exams between 15 and 22 weeks. Our results indicate that among nulliparous women, the risk of cesarean section increased from 10% when the ultrasound-based gestational age exceeded the LMP-based estimate by 4 days to 60% when the discrepancy increased to 21 days. Moreover, for each additional day the ultrasound-based estimate exceeded the LMP-based estimate, birth weight was higher by 9.6 g. Our findings indicate that a positive discrepancy (i.e., ultrasound-based estimate exceeds LMP-based estimate) in gestational age is associated with an increased risk of cesarean section. A negative discrepancy, by contrast, may reflect early intrauterine growth restriction and an increased risk of low birth weight.

YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth

Background Homeless and unstably housed (H/UH) youth are disproportionately affected by sexual health issues, including human immunodeficiency virus/sexually transmitted diseases, teen pregnancy, and dating violence, and are at a higher risk for poor mental health and underutilization of services. Research suggests that linking health care to H/UH adolescents might help improve their continuity of care, with most preferring to access health care information via the Internet. YTH StreetConnect is a dual-purpose mobile app that helps H/UH youth access health and vital services in Santa Clara County, CA, USA. We developed YTH StreetConnect PRO in parallel with the youth app as a companion tablet app for providers who serve H/UH youth. Objective The objective of our study was to develop a mobile app to support H/UH youth and their providers in accessing health and vital resources, and to conduct usability and feasibility testing of the app among H/UH youth and technical consultants with local expertise in serving H/UH youth. Methods Formative research included a literature review on H/UH youths’ mobile phone and Internet usage. In January 2015, we conducted interviews with medical and service providers of H/UH youth. Usability and feasibility testing were done with target audiences. Additionally, we conducted focus groups with youth regarding the app’s youth friendliness, accessibility, and usefulness. Results H/UH youth and their providers noted the app’s functionality, youth friendliness, and resources. Usability testing proposed improvements to the app, including visual updates to the user interface, map icons, new underrepresented resource categories, and the addition of a peer rating system. Limitations included a small sample size among H/UH youth and providers and a single site for the study (Santa Clara County, CA), making the findings ungeneralizable to the US population. Conclusions YTH StreetConnect is a promising way to increase service utilization, provide referral access, and share resources among H/UH youth and providers. Input from H/UH youth and providers offers insights on how to improve future models of YTH StreetConnect and similar programs that assist H/UH youth.

The Need to Promote Sexual Health in America: A New Vision for Public Health Action

Abstract Sexual health is considered to be a state of wellness with physical, emotional, mental, and social dimensions. Sexual health can contribute to our overall well-being in each of these dimensions. However, despite the intrinsic importance and positive aspects of sexuality in our lives, the United States presently faces significant challenges related to the sexual health of its citizens, including human immunodeficiency virus, other sexually transmitted infections, viral hepatitis, unintended pregnancies, sexual violence, sexual dysfunction, and cancers in reproductive tracts with serious disparities among the populations affected. In particular, high rates of poverty, income inequality, low educational attainment, stigma, racism, sexism, and homophobia can make it more difficult for some individuals and communities to protect their sexual health. Given that many pressing public health issues in the United States are related to sexual health and that sexual health has been increasingly recognized as an important national health priority, now is the time to energize and focus our efforts toward optimal sexual health of the population. In this paper, we outline the rationale for addressing sexual health as a means to better promote overall health and address sexuality related morbidities. In addition, we present a logic model outlining an approach for advancing sexual health in the United States, as well as a range of action steps for consideration by public health practitioners, researchers, and policymakers.