Kelly L'Engle

X-Rated Sexual Attitudes and Behaviors Associated With U.S. Early Adolescents' Exposure to Sexually Explicit Media

Correlates of use and subsequent sexual attitudes and behaviors predicted by exposure to sexually explicit content (i.e., pornography and erotica) in adult magazines, X-rated movies, and the Internet were examined in a prospective survey of a diverse sample of early adolescents (average age at baseline = 13.6 years; N = 967). Two-thirds (66%) of males and more than one-third (39%) of females had seen at least one form of sexually explicit media in the past year. At baseline, being black, being older, and having less-educated parents, lower socioeconomic status, and high need for sensation were related to greater exposure for both males and females. Longitudinal analyses showed that early exposure for males predicted less progressive gender role attitudes, more permissive sexual norms, sexual harassment perpetration, and having oral sex and sexual intercourse two years later. Early exposure for females predicted subsequently less progressive gender role attitudes, and having oral sex and sexual intercourse. Implications for healthy sexual socialization are discussed.

Evaluating feasibility, reach and potential impact of a text message family planning information service in Tanzania.

BACKGROUND The objective of this research was to evaluate the feasibility, reach and potential behavioral impact of providing automated family planning information via mobile phones to the general public in Tanzania. STUDY DESIGN Data from users of the Mobile for Reproductive Health (m4RH) program were collected during the 10-month pilot period. First, contraceptive methods queried by each user were electronically logged by the mobile phone system. Second, four text questions assessing gender, age, promotion point and potential family planning impact were sent to every user. RESULTS During the pilot period, 2870 unique users accessed m4RH in Tanzania, resulting in 4813 queries about specific contraceptive methods. Among those responding to text questions, 56% were female and approximately 60% were 29 or younger years in age. A variety of changes in family planning use were mentioned after using m4RH, with reported changes consistent with where users are in their reproductive life cycle. CONCLUSIONS Reaching younger people, women and men of reproductive age with family planning information delivered via mobile phone is recommended.

There are some questions you may not ask in a clinic: Providing contraception information to young people in Kenya using SMS ☆

To evaluate the acceptability, information access, and potential behavioral impact of providing contraception information via text message on mobile phones to young people in Kenya.

Women's roles in voluntary medical male circumcision in Nyanza Province, Kenya.

Women are an important audience for voluntary medical male circumcision (VMMC) communication messages so that they know that VMMC provides only partial protection against HIV. They may also be able to influence their male partners to get circumcised and practice other HIV protective measures after VMMC. This study was conducted in two phases of qualitative data collection. Phase 1 used in-depth interviews to explore women’s understanding of partial protection and their role in VMMC. Phase 2 built on the findings from the Phase 1, using focus groups to test VMMC communication messages currently used in Nyanza Province and to further explore women’s roles in VMMC. Sixty-four sexually active women between the ages of 18 and 35 participated. In Phase 1, all women said they had heard of partial protection, though some were not able to elaborate on what the concept means. When women in Phase 2 were exposed to messages about partial protection, however, participants understood the messages well and were able to identify the main points. In Phases 1 and 2, many participants said that they had discussed VMMC with their partner, and for several, it was a joint decision for the man to go for VMMC. These findings suggest that current VMMC messaging is reaching women, though communications could more effectively target women to increase their ability to communicate about partial HIV protection from VMMC. Also, women seem to be playing an important role in encouraging men to get circumcised, so reaching out to women could be a valuable intervention strategy for increasing VMMC uptake and promoting use of other HIV protective measures after VMMC.

Mobile Phone Interventions for Adolescent Sexual and Reproductive Health: A Systematic Review.

CONTEXT: Interventions for adolescent sexual and reproductive health (ASRH) are increasingly using mobile phones but may not effectively report evidence. OBJECTIVE: To assess strategies, findings, and quality of evidence on using mobile phones to improve ASRH by using the mHealth Evidence Reporting and Assessment (mERA) checklist recently published by the World Health Organization mHealth Technical Evidence Review Group. DATA SOURCES: Systematic searches of 8 databases for peer-reviewed studies published January 2000 through August 2014. STUDY SELECTION: Eligible studies targeted adolescents ages 10 to 24 and provided results from mobile phone interventions designed to improve ASRH. DATA EXTRACTION: Studies were evaluated according to the mERA checklist, covering essential mHealth criteria and methodological reporting criteria. RESULTS: Thirty-five articles met inclusion criteria. Studies reported on 28 programs operating at multiple levels of the health care system in 7 countries. Most programs (82%) used text messages. An average of 41% of essential mHealth criteria were met (range 14%–79%). An average of 82% of methodological reporting criteria were met (range 52%–100%). Evidence suggests that inclusion of text messaging in health promotion campaigns, sexually transmitted infection screening and follow-up, and medication adherence may lead to improved ASRH. LIMITATIONS: Only 3 articles reported evidence from lower- or middle-income countries, so it is difficult to draw conclusions for these settings. CONCLUSIONS: Evidence on mobile phone interventions for ASRH published in peer-reviewed journals reflects a high degree of quality in methods and reporting. In contrast, current reporting on essential mHealth criteria is insufficient for understanding, replicating, and scaling up mHealth interventions.

“I love my ECPs”: challenges to bridging emergency contraceptive users to more effective contraceptive methods in Ghana

Background and methods Emergency contraceptive pills (ECPs) are becoming more popular, yet little is known about the contraceptive preferences of women who take ECPs. Women purchasing ECPs were recruited from pharmacies in Accra, Ghana. A total of 24 semi-structured, qualitative interviews were conducted in May 2008. Results Nearly all participants preferred ECPs to other contraceptive methods. Although fear of side effects from oral contraceptive pills (OCPs), intrauterine devices and injectables were deterrents to use of those methods, side effects from ECPs were acceptable to this small and highly self-selected group of ECP users. Participants had little knowledge about how other contraceptive methods work and expressed a strong distrust and dislike of condoms. Discussion and conclusion Study participants loved their ECPs, despite minor discomforts like bleeding, and most had no concerns about repeated use, though these findings may not apply to women outside Accra or women who obtain ECPs from non-pharmacy settings. Future interventions should work to dispel myths about OCPs, condoms and other modern methods, and focus on basic contraception education.

Understanding partial protection and HIV risk and behavior following voluntary medical male circumcision rollout in Kenya

In the midst of scaling up voluntary medical male circumcision (VMMC) in Kenya, there is concern that men do not adequately understand that circumcision provides only partial protection against HIV. The study goal was to determine men’s understanding of partial protection, perceptions of HIV risk before and after VMMC and use of protective measures following VMMC. In-depth interviews with 44 men aged 18–39 years recently circumcised or planning to undergo VMMC were conducted in two urban and rural districts in Nyanza Province, Kenya. Participants described partial protection as the need to continue using other HIV protective measures such as condoms, with numbers such as a ‘60 percent protection’ or ‘not 100 percent protection’, and described how circumcision reduces HIV transmission such as reduced penile bruising or bleeding. Most said their HIV risk before VMMC was high and that VMMC would reduce their risk moderately. Participants demonstrated good understanding of partial protection and there was little suggestion of risk compensation following VMMC.

Levels of alcohol use and history of HIV testing among female sex workers in Mombasa, Kenya

HIV testing is a critical first step to accessing HIV care and treatment, particularly for high-risk groups such as female sex workers (FSWs). Alcohol use may be a barrier to accessing HIV services, including HIV testing. We analyzed data from a cross-sectional survey of 818 FSWs in Mombasa, Kenya, and estimated the association between different levels of alcohol use and having never tested for HIV. In multivariable analyses, higher levels of alcohol consumption were associated with having never tested for HIV (PR 1.60; 95% CI: 1.07, 2.40). Future interventions should explore whether reducing harmful drinking improves HIV testing among FSWs.

Influence of perceived interactivity of a sexual health text message service on young people’s attitudes, satisfaction and repeat use

Sexual health text message services are becoming an increasingly popular way to reach young people with sexual health information. A variety of service types exist: some send automated messages on a set schedule; others provide personalized responses to individual questions. Young peoples perceptions of interactivity, which is often based on system responsiveness, may vary. This study examines perceptions of interactivity for users of a two-way text message service that connects young people directly with a health educator and examines the relationship between perceived interactivity and attitudes toward the service, service satisfaction, and repeated service use. Data from 131 users in the southeastern U.S.A. were analysed. Perceived interactivity was associated with positive attitudes, user satisfaction and repeat use. Data suggest that for sexual health information seeking, young people may view a program as more useful if they perceive it is interactive. Services that provide a back-and-forth dialog between health educators and users may be perceived as interactive, and those perceptions of interactivity can influence attitudes toward the service as well as behaviors, such as using the service repeatedly. Since such services offer accurate and timely health information, repeated use allows for the additional exchange of health information and educational opportunities.

Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: a cross-sectional analysis

Objectives Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya. Methods In-person interviews were conducted with 816 FSWs in Mombasa, Kenya. Sample participants were: recruited from HIV prevention drop-in centres, 18 years or older and moderate risk drinkers. Early initiation was defined as first engaging in sex work at 17 years or younger. Logistic regression modelled outcomes as a function of early initiation, adjusting for drop-in centre, years in sex work, supporting others and HIV status. Results FSWs who initiated sex work early were significantly less likely to report consistent condom use with paying sex partners compared with those who initiated sex work in adulthood. There was no significant difference between groups in consistent condom use with non-paying sex partners. FSWs who initiated sex work early endorsed less condom negotiation self-efficacy with paying sex partners compared with FSWs who did not initiate sex work early. Conclusions Findings highlight a need for early intervention for at-risk youth and adolescent FSWs, particularly in relation to HIV sexual risk behaviours. Evidence-based interventions for adolescent FSWs or adult FSWs who began sex work in adolescence should be developed, implemented and evaluated.