Sarah B. Maness

Utilizing a Social Determinant of Health Framework as Determinants of Perceived Behavioral Control.

Health disparities reflect inequalities in health outcomes among different populations. As a planning tool for researchers and practitioners to address health disparities, multiple frameworks utilizing social determinants of health have been proposed. Perceived behavioral control, a construct within the Integrative Behavioral Model, reflects how much control one feels over a health behavior and how easy or difficult the behavior is to enact under internal and external barriers. The purpose of this commentary is to suggest how a unified social determinant of health framework can be utilized as a predictor and determinant of the construct perceived behavioral control.

Rural and Urban Differences in Sexual Behaviors Among Adolescents in Florida

The national teen birth rate is higher in rural compared to urban areas. While national data suggest rural areas may present higher risk for adverse sexual health outcomes among adolescents, it is unknown whether there are differences within the state of Florida. Overall, Florida has poorer sexual health indicators for adolescents compared to national rates. The purpose of this study was to assess differences in sexual behaviors among Florida adolescents by rural–urban community location. This study includes baseline data from a randomized controlled trial conducted in Florida high schools. Of the 6316 participants, 74% were urban and 26% were rural. Participants responded to questions on sexual behaviors, sexual behavior intentions, and demographics. We estimated the effect of rural–urban status on risk outcomes after controlling for demographic variables using generalized linear mixed models. More teens from rural areas reported ever having sex (24.0%) compared to urban teens (19.7%). No significant differences were observed for most of sexual behaviors assessed. Nonetheless, urban participants were less likely to intend to have sex without a condom in the next year compared to rural participants (aOR = 0.76, 95% CI 0.63–0.92). Overall, there were no major differences in sexual behaviors between rural and urban adolescents in Florida. However, sexual intentions differed between rural and urban adolescents; specifically, rural adolescents were more likely to intend to have sex without a condom in the next year compared to urban adolescents. Understanding the specific disparities can inform contraception and sexual health interventions among rural youth.

Social influences on sorority and fraternity member smoking

ABSTRACT Objective: To understand how the Greek system uniquely influences smoking attitudes, beliefs, and behaviors among college students who belong to a social sorority or fraternity. Participants: Active members of sororities (n = 16) and fraternities (n = 17) were interviewed between February 2013 and October 2015. Methods: In-depth interviews were conducted examining the social influences of the Greek system on member smoking. Transcribed interviews were coded and analyzed for themes. Results: Sorority and fraternity members experienced different social influences on smoking. Sorority stigmatization of smoking outside bars or parties caused sorority members to hide their smoking. Fraternity members had no social penalties for smoking and allowed smoking at the fraternity house. Fraternity members influenced both fraternity members and sorority members to smoke by sharing cigarettes and smoking at parties. Conclusions: Sororities and fraternities have created social environments that both promote smoking and stigmatize it, presenting unique challenges in college student smoking prevention and cessation efforts.

HPV awareness, knowledge and vaccination attitudes among church-going African-American women

OBJECTIVES The purpose of this exploratory study was to improve understanding of the sociodemographic correlates of human papillomavirus (HPV) awareness, knowledge, and vaccination attitudes in a convenience sample of church-going, African-American women and how knowledge about HPV-related cancers relates to vaccination attitudes for girls and boys. METHODS Participants (N = 308) answered survey questions about HPV awareness, knowledge, and vaccination attitudes. Associations between variables were assessed using Bonferroni-adjusted chi-square tests and regression analyses. RESULTS Younger age was associated with having heard of HPV and willingness to vaccinate a daughter or son in covariate-adjusted analyses. Younger age and greater education were associated with knowledge that HPV causes cervical cancer. A positive association existed between willingness to vaccinate a daughter or son based on knowledge of the number of cancers associated with HPV. Knowledge that HPV was related to non-cervical cancers was significantly associated with greater willingness to vaccinate sons. CONCLUSIONS Knowledge that HPV causes multiple cancers is important to willingness to vaccinate a child. Education campaigns should emphasize that HPV is also related to non-cervical cancers. African-American women of older age and less education might benefit from church-based HPV educational campaigns.

Social Determinants of Health and Human Papillomavirus Vaccination Among Young Adults, National Health Interview Survey 2016

Human papillomavirus (HPV) vaccination has the potential to reduce the burden of anogenital cancers. Vaccine uptake remains suboptimal, especially among young adults. Social determinants of health (SDOH) are societal level conditions that may indirectly influence health behaviors, including HPV vaccination. The purpose of this study was to assess HPV vaccination and SDOH among young adult women and men. The 2016 National Health Interview Survey was restricted to participants ages 18–26 (n = 3593). The Healthy People 2020 SDOH Framework was used to identify variables for economic stability, health and healthcare, education, social and community context, and neighborhood and built environment. Survey-weighted logistic regression models identified SDOH variables significantly associated with HPV vaccination. Reported HPV vaccination occurred for 45.7% of women and 14.5% of men in the sample. Among women, education determinants—highest level of education completed and English language—were significantly associated with HPV vaccination. Men (adjusted OR 0.65, 95% CI 0.54, 0.79) and women (adjusted OR 0.66, 95% CI 0.49, 0.90) who did not use the Internet to look up health information were at lower odds to be vaccinated for HPV. These findings can inform future HPV vaccine uptake efforts by focusing specifically on these SDOH areas—education and health and healthcare. Identifying SDOH leverage points is critical to promoting HPV vaccination and ultimately reducing HPV-associated cancers.

Current Age, Age at First Sex, Age at First Homelessness, and HIV Risk Perceptions Predict Sexual Risk Behaviors among Sexually Active Homeless Adults

While HIV disproportionately impacts homeless individuals, little is known about the prevalence of HIV risk behaviors in the southwest and how age factors and HIV risk perceptions influence sexual risk behaviors. We conducted a secondary data analysis (n = 460) on sexually active homeless adults from a cross-sectional study of participants (n = 610) recruited from homeless service locations, such as shelters and drop-in centers, in an understudied region of the southwest. Covariate-adjusted logistic regressions were used to assess the impact of age at homelessness onset, current age, age at first sex, and HIV risk perceptions on having condomless sex, new sexual partner(s), and multiple sexual partners (≥4 sexual partners) in the past 12 months. Individuals who first experienced homelessness by age 24 were significantly more likely to report condomless sex and multiple sexual partners in the past year than those who had a later onset of their first episode of homelessness. Individuals who were currently 24 years or younger were more likely to have had condomless sex, new sexual partners, and multiple sexual partners in the past 12 months than those who were 25 years or older. Those who had low perceived HIV risk had lower odds of all three sexual risk behaviors. Social service and healthcare providers should consider a younger age at homelessness onset when targeting HIV prevention services to youth experiencing homelessness.

Evaluating the Effects of the Teen Outreach Program on Positive Youth Development Constructs

Introduction: The Teen Outreach Program (TOP) is a positive youth development (PYD) program that seeks to reduce the risk of adolescent pregnancy, school dropout, and course failure. As TOP has not been evaluated for its impact on PYD constructs, our purpose was to assess this potential. Methods: A pair-matched, cluster randomized controlled trial to evaluate TOP among youth in 26 high schools was conducted in 2013-2014. Youth (N=3740) were surveyed at baseline and immediately following program completion. A linear mixed effects model compared scores of the Lerner’s Five Cs measure of PYD between treatment and control youth and by race/ethnicity and gender subgroups. Results: After a multiple comparison adjustment, no statistically significant results were observed. Conclusions: Despite the lack of statistically significant findings, the current study can provide insight for future evaluations of TOP regarding adaptation and evaluation of core components, implementation, PYD impacts, and sexual and reproductive health outcomes.

Effects of primary care physician density, urologist presence, and insurance status on stage of diagnosis for urologic malignancies

OBJECTIVE To evaluate effects of PCP density, insurance status, and urologist presence on stage of diagnosis for urologic malignancies. Cancer stage at diagnosis is an important outcome predictor. Studies have shown an inverse relationship to primary care physician (PCP) density and insurance coverage with stage of cancer diagnosis. METHODS Data was obtained from OK2Share, an Oklahoma Central Cancer Registry, for bladder, kidney, and prostate cancer from 2000 to 2010. Physician data was obtained through the State Licensing Board. The 2010 national census was used for population data. High PCP density was defined as greater than or equal to the median value: 3.17 PCP/10,000 persons. Chi-square and multivariate logistic regressions were used to analyze effects of PCP density, insurance status, and urologist presence on advanced stage diagnosis. RESULTS 27,086 patients were identified across 77 counties. As PCP density increased by 1 PCP/10,000 persons, the odds ratios (OR) of an advanced stage at diagnosis were 0.383, 0.468, 0.543 for bladder, kidney, and prostate cancer respectively. Compared to private insurance, being uninsured had OR of 1.61 and 2.45 respectively for kidney and prostate cancers. The OR of an advanced stage diagnosis for bladder and prostate cancer were 3.77 and 1.73, respectively, in counties with a urologist. CONCLUSIONS Increased PCP density and insurance coverage reduced the odds of an advanced diagnosis. Implementation of policies to improve access to healthcare including through increasing PCP density and reducing the number of uninsured patients should result in diagnosis at an earlier stage, which will likely improved cancer-related outcomes.

Examining Sexuality Education Preferences Among Youth at Risk for Poor Sexual Health Outcomes Based on Social Determinants of Health Factors

ABSTRACT At-risk adolescents may experience Social Determinants of Health (SDoH) that lead to higher rates of risky sexual behavior, including increased risk of pregnancy and sexually transmitted infections. These SDoH may include components such as unstable family structures, incomplete education, and poverty. Targeting at-risk youth for sexuality education is one way to work toward decreasing sexual health disparities. However, preferences for sexuality education approaches may differ among at-risk youth by additional factors including sex and sexual orientation. The purpose of this study was to describe sexuality education preferences among at-risk youth and how sexuality education preferences differ based on sex and sexual orientation in an at-risk sample of high school-aged youth in Texas. Results indicate sexuality education preferences differ based on sex and sexual orientation when examined by sexual health topics and methods of delivery. Implications of this study indicate including at-risk youth in sexual health programs may be a way to target those at-risk of adverse SDoH, but these groups also have specific preferences for sexuality education.

Using the Integrative Model of Behavioral Prediction to Predict Vegetable Subgroup Consumption among College Students

ABSTRACT Background: The United States Department of Agriculture (USDA) currently recommends that young adults consume 2.5–3 cups of vegetables daily, while also providing weekly recommendations for 5 vegetable subgroups: dark green, red and orange, beans and peas, starchy, and other. Purpose: The purpose of this study was to explore theory-based determinants of consumption for 5 USDA vegetable subgroups among college students. Methods: Operationalizing the integrative model of behavioral prediction (IMB), a survey was developed and distributed online to college students (n = 386). Linear regression models were used to predict behavioral intentions of each subgroup with attitudes, perceived norms, and perceived behavioral control (PBC), and logistic regression models predicted whether students met (or did not meet) recommendations, with intentions and PBC. Results: Collectively, IBM constructs accounted for 40.5%–54.6% of the variance of intentions and 14.2%–44.3% of the variance of each subgroup. Discussion: Research exploring determinants of vegetable subgroups is rarely done. This study demonstrated that young adults hold different beliefs about subgroups, and theory-based determinants of subgroups vary. Translation to Health Education Practice: Vegetable consumption is associated with many health benefits, and understanding significant theory-based determinants of each subgroup can help future practitioners develop targeted and tailored programs that promote vegetable quantity and variety.