Rachel Skinner

Facilitating chlamydia testing among young people: a randomised controlled trial in cyberspace

Objectives Chlamydia notifications have been rising in Australia for over a decade and are highest in young people. This study aimed to evaluate the impact of an internet-based intervention on chlamydia testing among young people 16–25 years. Methods In this randomised controlled trial, recruitment, data collection, study interventions and follow-up occurred entirely in cyberspace, facilitated by a website. Eligible participants were aged 16–25 years and resided in Australia. The intervention group received personalised emails inviting interaction about chlamydia testing, while the control group received regular impersonal emails. Primary outcome was self-reported chlamydia testing at 6-month follow-up; secondary outcomes were condom use and changes in knowledge and attitudes. Results 704 young people completed baseline information, 40 were excluded and five withdrew prior to follow-up. The follow-up rate was 47.3% overall. In the intervention group, 40.6% (95% CI 30.7% to 51.1%) reported having had a chlamydia test at follow-up compared with 31.0% (95% CI 24.8% to 37.2%) in the control group (p=0.07). A per-protocol analysis found that those who engaged in email interaction were more likely to report chlamydia test uptake compared with those in the control group (52.5%, 95% CI 39.3 to 65.4% cf 31.0%, 95% CI 24.8% to 37.2%, p=0.002). There were no differences in secondary outcomes between groups. Conclusions This is the first randomised controlled trial undertaken in cyberspace to promote chlamydia testing. E-technology may be useful in promoting chlamydia testing and healthcare seeking behaviour in young people.

Post Hoc Analysis of the PATRICIA Randomized Trial of the Efficacy of Human Papillomavirus Type 16 (HPV-16)/HPV-18 AS04-Adjuvanted Vaccine against Incident and Persistent Infection with Nonvaccine Oncogenic HPV Types Using an Alternative Multiplex Type-Specific PCR Assay for HPV DNA

ABSTRACT The efficacy of the human papillomavirus type 16 (HPV-16)/HPV-18 AS04-adjuvanted vaccine against cervical infections with HPV in the Papilloma Trial against Cancer in Young Adults (PATRICIA) was evaluated using a combination of the broad-spectrum L1-based SPF10 PCR-DNA enzyme immunoassay (DEIA)/line probe assay (LiPA25) system with type-specific PCRs for HPV-16 and -18. Broad-spectrum PCR assays may underestimate the presence of HPV genotypes present at relatively low concentrations in multiple infections, due to competition between genotypes. Therefore, samples were retrospectively reanalyzed using a testing algorithm incorporating the SPF10 PCR-DEIA/LiPA25 plus a novel E6-based multiplex type-specific PCR and reverse hybridization assay (MPTS12 RHA), which permits detection of a panel of nine oncogenic HPV genotypes (types 16, 18, 31, 33, 35, 45, 52, 58, and 59). For the vaccine against HPV types 16 and 18, there was no major impact on estimates of vaccine efficacy (VE) for incident or 6-month or 12-month persistent infections when the MPTS12 RHA was included in the testing algorithm versus estimates with the protocol-specified algorithm. However, the alternative testing algorithm showed greater sensitivity than the protocol-specified algorithm for detection of some nonvaccine oncogenic HPV types. More cases were gained in the control group than in the vaccine group, leading to higher point estimates of VE for 6-month and 12-month persistent infections for the nonvaccine oncogenic types included in the MPTS12 RHA assay (types 31, 33, 35, 45, 52, 58, and 59). This post hoc analysis indicates that the per-protocol testing algorithm used in PATRICIA underestimated the VE against some nonvaccine oncogenic HPV types and that the choice of the HPV DNA testing methodology is important for the evaluation of VE in clinical trials. (This study has been registered at ClinicalTrials.gov under registration no. NCT00122681.)Efficacy of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infections with HPV in the PApilloma TRIal against Cancer In young Adults (PATRICIA; NCT00122681) was evaluated using a combination of the broad-spectrum L1-based SPF 10 PCR-DEIA/LiPA 25 system with type-specific PCRs for HPV-16 and 18. Broad-spectrum PCR assays may underestimate the presence of HPV genotypes present at relatively low concentrations in multiple infections, due to competition between genotypes. Therefore, samples were retrospectively re-analyzed using a testing algorithm incorporating SPF 10 PCR-DEIA/LiPA 25 plus a novel E6-based multiplex type-specific PCR and reverse hybridization assay (MPTS12 RHA), which permits detection of a panel of nine oncogenic HPV genotypes (types 16, 18, 31, 33, 35, 45, 52, 58 and 59). For vaccine HPV types 16 and 18, there was no major impact on estimates of vaccine efficacy (VE) for incident, 6-month or 12-month persistent infections when including MPTS12 RHA in the testing algorithm, versus the protocol-specified algorithm. However, the alternative testing algorithm showed greater sensitivity than the protocol-specified algorithm for detection of some non-vaccine oncogenic HPV types. More cases were gained in the control group than in the vaccine group, leading to higher point estimates of VE for 6-month and 12-month persistent infections for the non-vaccine oncogenic types included in the MPTS12 RHA assay (types 31, 33, 35, 45, 52, 58 and 59). This post-hoc analysis indicates that the per-protocol testing algorithm used in PATRICIA underestimated the VE against some non-vaccine oncogenic HPV types and that choice of HPV DNA testing methodology is important for the evaluation of VE in clinical trials.

Fit4YAMs: Structuring a Lifestyle Intervention for Rural Overweight and Obese Young Adult Males Using Participatory Design

PURPOSE Young adult males (YAMs) are understudied with respect to lifestyle interventions to address overweight and obesity in this group. This study reports on the participatory design of the structure and delivery of the Fit4YAMs text message-based lifestyle intervention for 18- to 25-year-old rural YAMs in Australia. METHODS Two semi-structured focus group discussions were held with six overweight or obese YAMs. Sessions explored their preferences for the structure and delivery of a weight loss intervention. Focus groups were recorded, and the contents transcribed verbatim for thematic analysis. RESULTS The YAMs were unanimous in their preference for a highly personalized intervention program, complete with personalized goal setting, personalized motivation and engagement strategies, and personalized text message content. A text message frequency of three-four messages per week was deemed optimal for this group. Minimal direct contact by the intervention team was requested, but with clear guidelines and reminders of key contacts whom they could contact should they require help and guidance. The YAMs also agreed that a comprehensive goal setting session and personalization session prior to commencement of the intervention would be best. CONCLUSIONS To engage rural YAMs in lifestyle interventions, a high degree of personalization of the program appears important. Although initially more time and resource intensive than a less personalized approach, it is essential to identify strategies to prevent and reverse weight gain in this hard to engage group. Maximizing their engagement using a more personalized approach could be the key to promoting long-term health outcomes in this group.

P4.024 Do New Media Affect Adolescent Sexual Attitudes and Behaviours? A Systematic Review

Introduction There is considerable public concern that new media (including the Internet and mobile phones) could be exposing young people to high levels of sexual content and may impact risky behaviour and/or risk for sexually transmissible infections. Methods The review was conducted in accordance with the PRISMA guidelines. Medline, EMBASE and PsychINFO were searched to the end of August 2012. Articles were included if they described the statistical association between exposure to sexual content in new media (viewing or engaging) and sexual attitudes or behaviours in young people (defined as < 25 years). Results There were 3834 articles identified, and five met the inclusion criteria: all were cross-sectional designs (four convenience samples), with the largest study containing 6054 participants. In four studies the exposure was viewing sexually explicit websites (SEW); a range of outcomes were assessed however each outcome variable was only measured in one or two of the included studies. Viewing SEW was significantly associated with: first intercourse < 15 years of age, ever having a sexual partner, > 1 partner in last 3 months, multiple lifetime partners, unprotected sex at last sex, drug and alcohol use at last sex, acceptance of casual sexual relationships, having casual sexual relationships, notions of women as sex objects, and approval of extra-marital sex. “Sexting” (sending or receiving sexual texts) was the exposure in the fifth study and was associated with ever having unprotected sex. Conclusion The relationship between SEW and sexual behaviours and attitudes was inconsistent. Engagement with sexual media appeared to be associated with markers of higher sexual interest and/or activity, but study size, methodological approach and inconsistencies in outcome measures prevented us from drawing conclusions regarding causality. No study explored associations with positive aspects of sexual development (e.g. sexual communication, sexual assertiveness, relationship quality). Further research in this emerging area is needed.

Risk-taking behaviours among younger adolescents in rural and regional New South Wales: preventing adverse health outcomes

Risk-taking behaviours during adolescence have negative short- and long-term health impacts. Maximizing the progress made through child health improvements and preventing the onset of adult ill-health require a much greater focus on health during adolescence. Understanding the biological and social factors that shape both risk and protective factors during adolescence provides the basis for effective prevention strategies. Effective prevention strategies require localized, disaggregated data to respond to heterogeneous life experiences. This paper reports on self-reported risk-taking behaviours among young adolescents growing up in rural communities in New South Wales, Australia. Quantitative analysis was undertaken to explore the relationship between risk-taking behaviour and key social determinants of health, including age, gender, cultural background and socio-economic status. It concludes that cross-cutting early intervention and prevention involving social work, youth work, education and health which builds young people’s resilience is likely to assist in the development of health-protective behaviours.

P4.078 A Literature Review of Sexting Attitudes and Risk Factors

Background Sexting includes sending, receiving or forwarding sexually explicit material via mobile phone, and occurs in about a third of teenagers. Much of the available information on this relatively recent phenomenon comes from popular press. Given the legal and psychosocial consequences of sexting, it is important to understand why teenagers sext and the characteristics of young people involved in sexting. Methods We conducted a structured literature review. PubMed, PsycINFO and Embase were searched to February 2013, using ‘sexting’ as key term. We extracted data on; reasons for sexting, attitudes, and factors statistically associated with sexting. Results Seven studies were included; most were cross-sectional, all were quantitative and conducted in the United States. Six studies assessed correlates of sexting in teenagers/young adults and found the following statistical associations; older adolescent, dating, sexually active, sexual risk behaviours, substance use, lower parental educational, peers sexting, and greater texting frequency. Girls were more likely to be senders, boys more likely to be receivers and to have asked someone to sext. Sexually active respondents were more likely to be both senders and receivers. Two studies explored attitudes about sexting finding those who sent pictures were more likely to consider sexting acceptable, over one third of non-sexters reported positive attitudes towards sexting, and most of those who sent pictures were bothered by having been asked to sext. Expecting serious legal consequences for getting caught sexting did not reduce reported sexting. Conclusion Many young people don’t perceive sexting negatively. Sexting may either be part of a cluster of risky sexual behaviours or in fact lead to sexual risk behaviour. Because of the cross-sectional nature of the studies, we were unable to determine causality. Additional research is needed to understand contexts in which sexting occurs, and motivations. Longitudinal designs are required to explore causality with sexual risk behaviour.