Nathan W. Stupiansky

Parent-son decision-making about human papillomavirus vaccination: a qualitative analysis

BackgroundLicensed for use in males in 2009, Human Papillomavirus (HPV) vaccination rates in adolescent males are extremely low. Literature on HPV vaccination focuses on females, adult males, or parents of adolescent males, without including adolescent males or the dynamics of the parent-son interaction that may influence vaccine decision-making. The purpose of this paper is to examine the decision-making process of parent-son dyads when deciding whether or not to get vaccinated against HPV.MethodsTwenty-one adolescent males (ages 13–17), with no previous HPV vaccination, and their parents/guardians were recruited from adolescent primary care clinics serving low to middle income families in a large Midwestern city. Dyad members participated in separate semi-structured interviews assessing the relative role of the parent and son in the decision regarding HPV vaccination. Interviews were recorded, transcribed, and coded using inductive content analysis.ResultsParents and sons focused on protection as a reason for vaccination; parents felt a need to protect their child, while sons wanted to protect their own health. Parents and sons commonly misinterpreted the information about the vaccine. Sons were concerned about an injection in the penis, while some parents and sons thought the vaccine would protect them against other sexually transmitted infections including Herpes, Gonorrhea, and HIV. Parents and sons recalled that the vaccine prevented genital warts rather than cancer. The vaccine decision-making process was rapid and dynamic, including an initial reaction to the recommendation for HPV vaccine, discussion between parent and son, and the final vaccine decision. Provider input was weighed in instances of initial disagreement. Many boys felt that this was the first health care decision that they had been involved in. Dyads which reported shared decision-making were more likely to openly communicate about sexual issues than those that agreed the son made the decision.ConclusionParents and sons play an active role in the decision-making process, with an individual’s role being influenced by many factors. The results of this study may be used to guide the messages presented by clinicians when recommending the HPV vaccine, and future vaccine uptake interventions.

Relations between sexually transmitted infection diagnosis and sexual compulsivity in a community-based sample of men who have sex with men

Objective: To assess relations between sexual compulsivity and a history of sexually transmitted infection (STI) diagnosis and testing among a community-based sample of men who have sex with men (MSM) in a mid-size urban area of the midwestern United States. Methods: Sexual health data were collected from 504 MSM in the metropolitan area of Indianapolis, Indiana, using a community-based participatory research approach. Sexual compulsivity scores were assessed using the Sexual Compulsivity Scale (SCS). Results: The reliability and construct validity of the SCS were determined to be high in the total study sample. Men who scored high on the SCS reported higher levels of sexual risk behaviour with both male and female partners and were significantly more likely to have been diagnosed with STI (including chlamydia, gonorrhoea, both hepatitis A and B, and syphilis) than other men. Men who scored high on the SCS were not more likely than other men to have been tested for STI, despite higher levels of sexual risk. Conclusions: The SCS may be useful as a supplemental instrument in public health programmes and healthcare settings that encourage men to assess their sexual behaviours and make decisions to pursue STI or HIV screening. For those already diagnosed with an STI, the SCS may help providers to identify the cognitive and affective components of sexual behaviours that increase the likelihood that an STI will be transmitted to a sexual partner.

Accuracy of Self-Reported Human Papillomavirus Vaccine Receipt Among Adolescent Girls and Their Mothers

PURPOSE The use of self-report of human papillomavirus (HPV) vaccination status has several implications for clinical care and research. Reports of HPV vaccination history of adolescent girls (ages: 14-17 years) and their mothers were compared with medical chart data to assess the accuracy of HPV vaccine recall. METHODS Adolescent girls (N = 74) and their mothers independently completed questionnaires regarding HPV vaccination history, which were compared with medical chart data to assess the accuracy of HPV vaccine recall. RESULTS There were high levels of inaccuracy between actual HPV vaccination and self-report of vaccine receipt. Both mothers and daughters had poor recall of HPV vaccination, and were more likely to underestimate than overestimate the coverage. Girls who accurately reported their vaccination status were not more likely to have been sexually active in the past 2 months (p = .75). CONCLUSIONS These findings have clinical and research implications, as self-report is relied on to assess young womens vaccination status in research settings or in the absence of medical records. These data address the still prevalent concern that HPV vaccination encourages adolescent sexual behavior. It is unlikely that sexual behaviors will change as a result of vaccination in the large percentage of girls who cannot recall being vaccinated.

Human papillomavirus vaccine and men: what are the obstacles and challenges?

Purpose of review The present review describes the indications for vaccinating men with the quadrivalent human papillomavirus (HPV) vaccine, reports on the US rates of male vaccination, and reviews the recent research on acceptability of vaccinating men and research on the cost-effectiveness of adding men to existing female HPV immunization programs. Recent findings Recent evidence shows that the quadrivalent HPV vaccine prevents several HPV-related diseases in men. However, despite the licensure of the vaccine in the USA for men 9 through 26 years of age, rates of male vaccination are very low. Research on acceptability, in general, indicates strong interest in vaccination among men, parents, and healthcare providers, though female vaccination is typically seen as a higher priority. Cost-effectiveness studies indicate that in the context of modest female vaccination rates and with the specification of a broad range of disease outcomes (e.g. genital warts, anogenital cancers, and oropharyngeal cancers), male vaccination can be quite cost-effective. Summary Men are at high risk for HPV infection and can benefit from vaccination, but vaccination rates among men remain extremely low. More research needs to be done on the predictors of uptake of HPV vaccine among men and on the development of interventions to increase male vaccination.

Impulse Control, Diabetes-Specific Self-Efficacy, and Diabetes Management Among Emerging Adults With Type 1 Diabetes

OBJECTIVE To explore the relationships among impulse control, diabetes-specific self-efficacy, and diabetes management behaviors among emerging adults with type 1 diabetes. METHODS A total of 204 high school seniors (M = 18.25 years, SD = .45, 55.9% females) with type 1 diabetes self-reported on impulse control, diabetes-specific self-efficacy, and diabetes management behaviors during the past 3 months. Mediation and path analyses were used to address aims. RESULTS Greater impulse control was associated with better diabetes management among these emerging adults. In addition, diabetes-specific self-efficacy partially mediated the relationship between impulse control and diabetes management. CONCLUSIONS Impulse control and diabetes-specific self-efficacy may be important in the management of type 1 diabetes among emerging adults. Diabetes-specific self-efficacy may play an important role in successful diabetes management among youth with lower impulse control.

When Condom Use is Not Condom Use: An Event‐Level Analysis of Condom Use Behaviors during Vaginal Intercourse

INTRODUCTION Little is known about event-level condom use errors during vaginal sex. AIMS The aim of this article is to examine factors associated with complete condom use compared to forms of incomplete condom use, including delayed condom application and early condom removal, over a 30-day period. METHODS Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Incomplete condom use was assessed during vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation multinomial logistic regression. MAIN OUTCOME MEASURES Condom use during vaginal sex: complete use, delayed application, early removal, and both delayed application/early removal. RESULTS Of 29,714 diary reports, 30% (8,876) included vaginal intercourse. Analyses were conducted (in 2009) on 83.2% of these intercourse events (6,325), during which condoms were used and for which participants provided complete data. Incomplete condom use included penetration before applying condoms during 12% of events (749), removing condoms before intercourse ended during 3.1% (198), and both types of incomplete use during 2% (129) of events. Erection quality (less than typical erect penile length and circumference, less rigidity, and difficulty maintaining erection) was associated with greater odds of incomplete use, as was a participants history of other recent incomplete use. Perceptions of condom comfort and recent previous complete use were protective factors against incomplete use. CONCLUSIONS Mens incomplete condom use is associated with recent condom use patterns, as well as with their physiological characteristics and perceptions of condoms during sexual intercourse. Event-level analyses such as these help describe how incomplete condom use occurs among individuals incorporating condoms into their sexual activities.

Event-level marijuana use, alcohol use, and condom use among adolescent women.

Background: It is widely believed that marijuana use and alcohol use directly intercede on successful condom use. However, measurement differences and inconsistent findings in past research remain unclear whether marijuana and alcohol work directly to influence condom behavior, or spuriously function through other factors that actually reflect an increased likelihood of vaginal sex. The current study prospectively disentangles the association of marijuana and alcohol use on condom behavior among adolescent women. Methods: Young women (N = 387; 14–17 years) provided daily sexual diaries as part of a longitudinal cohort study (1999–2009) of sexual behavior and sexual relationships. To separate the effects of marijuana and alcohol use on vaginal sex from condom use (when vaginal sex occurs), we estimated a 3-category outcome variable (no vaginal sex, vaginal sex with a condom, vaginal sex without a condom), alternating no sex (Model 1) and sex without a condom (Model 2) as the referent categories. Generalized estimating equation multinomial logistic regression adjusted odds ratios for multiple sexual events from the same young woman over time. Results: Subjects contributed 14,538 coital events; 30% of these events were condom-protected. Neither marijuana nor alcohol use was directly associated with lower condom use; the strongest effect of condom use (adjusted odds ratio) and nonuse was performance of these behaviors in the past week. Conclusions: This study finds no evidence of a relationship between marijuana or alcohol use and condom nonuse. Both condom use and nonuse were identified as consistent behavioral patterns, regardless of the effect of marijuana and alcohol use.

Health beliefs and vaccine costs regarding human papillomavirus (HPV) vaccination among a U.S. national sample of adult women.

OBJECTIVE Health beliefs have been found to be significant predictors of vaccine acceptability and uptake, including attitudes about HPV vaccine. In this study, we examined whether the predictive strength of health beliefs varied as a function of vaccine cost among adult women. METHODS During April 2009, data were collected from a nationally representative internet sample of 1323 US-resident women aged 27-55 years. Participants completed items related to sociodemographics, health beliefs, and HPV vaccine acceptability. Acceptability was measured at three levels of cost: free,

Catching Up or Missing Out? Human Papillomavirus Vaccine Acceptability Among 18- to 26-Year-old Men Who Have Sex With Men in a US National Sample.

30/dose, and

Human papillomavirus vaccine acceptability among a national sample of adult women in the USA

120/dose. RESULTS Multiple linear regression (MLR) revealed that health belief variables accounted for 29.7% of the variability in overall HPV vaccine acceptability. However, there was a linear and significant decrease in R(2) values from 0.31 for a free vaccine, to 0.25 for a