Browsing by Subject "Sexual health"
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Item Four year efficacy of prophylactic human papillomavirus quadrivalent vaccine against low grade cervical, vulvar, and vaginal intraepithelial neoplasia and anogenital warts: randomised controlled trial(BMJ Publishing Group, 2010-07-20) The FUTURE I/II Study Group; Dillner, Joakim; Kjaer, Susanne K.; Wheeler, Cosette M.; Sigurdsson, Kristján; Iversen, Ole-Erik; Hernandez-Avila, Mauricio; Perez, Gonzalo; Brown, Darron R.; Koutsky, Laura A.; Tay, Eng Hseon; García, Patricia; Ault, Kevin A.; Garland, Suzanne M.; Leodolter, Sepp; Olsson, Sven-Eric; Tang, Grace W.K.; Ferris, Daron G.; Paavonen, Jorma; Lehtinen, Matti; Steben, Marc; Bosch, Xavier; Joura, Elmar A.; Majewski, Slawomir; Muñoz, Nubia; Myers, Evan R.; Villa, Luisa L; Taddeo, Frank J.; Roberts, Christine; Tadesse, Amha; Bryan, Janine T.; Maansson, Roger; Lu, Shuang; Vuocolo, Scott; Hesley, Teresa M.; Barr, Eliav; Haupt, Richard; Medicine, School of MedicineObjectives To evaluate the prophylactic efficacy of the human papillomavirus (HPV) quadrivalent vaccine in preventing low grade cervical, vulvar, and vaginal intraepithelial neoplasias and anogenital warts (condyloma acuminata). Design Data from two international, double blind, placebo controlled, randomised efficacy trials of quadrivalent HPV vaccine (protocol 013 (FUTURE I) and protocol 015 (FUTURE II)). The trials were to be 4 years in length, and the results reported are from final study data of 42 months’ follow-up. Setting Primary care centres and university or hospital associated health centres in 24 countries and territories around the world. Participants 17 622 women aged 16-26 years enrolled between December 2001 and May 2003. Major exclusion criteria were lifetime number of sexual partners (>4), history of abnormal cervical smear test results, and pregnancy. Intervention Three doses of quadrivalent HPV vaccine (for serotypes 6, 11, 16, and 18) or placebo at day 1, month 2, and month 6. Main outcome measures Vaccine efficacy against cervical, vulvar, and vaginal intraepithelial neoplasia grade I and condyloma in a per protocol susceptible population that included subjects who received all three vaccine doses, tested negative for the relevant vaccine HPV types at day 1 and remained negative through month 7, and had no major protocol violations. Intention to treat, generally HPV naive, and unrestricted susceptible populations were also studied. Results In the per protocol susceptible population, vaccine efficacy against lesions related to the HPV types in the vaccine was 96% for cervical intraepithelial neoplasia grade I (95% confidence interval 91% to 98%), 100% for both vulvar and vaginal intraepithelial neoplasia grade I (95% CIs 74% to 100%, 64% to 100% respectively), and 99% for condyloma (96% to 100%). Vaccine efficacy against any lesion (regardless of HPV type) in the generally naive population was 30% (17% to 41%), 75% (22% to 94%), and 48% (10% to 71%) for cervical, vulvar, and vaginal intraepithelial neoplasia grade I, respectively, and 83% (74% to 89%) for condyloma. Conclusions Quadrivalent HPV vaccine provided sustained protection against low grade lesions attributable to vaccine HPV types (6, 11, 16, and 18) and a substantial reduction in the burden of these diseases through 42 months of follow-up.Item The Impact of Sexual Identity Development on the Sexual Health of Youth Formerly in the Foster Care System(2019-02) Brandon-Friedman, Richard A.; Pierce, Barbara; Fortenberry, J. Dennis; Thigpen, Jeffrey; Wahler, ElizabethYouth in the foster care system receive less sexual and reproductive health education, experience higher levels of negative sexual health outcomes, and engage in more risky sexual behaviors than peers not in the foster care system. Counteracting these concerns requires understanding the processes that contribute to these outcomes. A conceptual model interfacing traditional identity development theories and social constructionist theories of social sexualization was developed that posited sociosexual input factors of sexual education and socialization, sexual abuse history, and adverse childhood experiences affect youths’ sexual identity development, which then impacts youths’ level of sexual health. Hierarchical linear regression determined the level of impact of sexual socialization on sexual health within a sample of youth formerly in the foster care system (n = 219). Whether sexual identity development level mediated the relationship between sexuality-related discussions and sexual health was tested as well as how relationship quality moderates the effects of sexuality-related topic discussions on sexual identity development. Further analysis explored differences between the experiences of youth who identified as sexual minorities and their peers who identified as heterosexual. Results indicated that gender identity, sexual orientation, adverse childhood experiences, sexual abuse history, and sexuality-related discussions with foster parents and with peers all impact sexual health. All four dimensions of sexual identity development significantly contributed to sexual health outcomes. Mediation occurred with two of the four sexual identity development dimensions, whereas no moderation effects were indicated. Youth who identified as sexual minorities and youth who identified as heterosexual had significantly different scores on three of four sexual identity development dimensions and youth who identified as sexual minorities had worse sexual health outcomes. Results indicate the importance of the sexual identity development process on sexual health and that youths’ sexual orientation identity must be considered when designing interventions to improve sexual health outcomes.Item Moving Beyond "Risky Sex": Adolescent Sexual Resilience and Sexual Health in Young Adulthood(2011-08-23) Cox, Mary L.; Leech, Tamara G.J.; Gronfein, William Philip; Goldfinger, JohnnySexual behaviors in adolescence establish the initial resources an individual carries into sexual relationships in adulthood. Current definitions of sexual resilience in adolescence are defined from a negative, risk-based lens. Resilience theory, more generally defined, considers both internal and external factors that promote adaptation to challenging situations. A direct, capital-based approach to studying adolescent sexual resilience has not been found in the extant literature and I propose that a new, more inclusive definition of sexual resilience in adolescence will be more strongly correlated with sexual health in young adults than the risk-based definition. This study creates mutually exclusive risk-based and capital-based measures of adolescent sexual resilience and examines their associations with sexual health outcomes in young adulthood. The data did not produce significant findings, yet descriptive results provide direction for future research. Research in this area is of critical importance as adolescence and young adulthood are unique life stages that involve significant development in areas that influence health, both short and long term. This research, through a proper resilience lens, will better guide adolescent sexual education to develop internal resources as well as provide adequate external resources for adolescents that promote better sexual health and agency outcomes in adulthood.Item Provider Attitudes, Preferences, and Practices Regarding Sexual and Reproductive Health for Adolescents and Young Adults with Sickle Cell Disease(Elsevier, 2021) Leroy-Melamed, Maayan; Jacob, Seethal; Shew, Marcia L.; Kazmerski, Traci M.; Pediatrics, School of MedicinePurpose: With improvements in life expectancy, adolescents and young adults (AYAs) with sickle cell disease (SCD) increasingly face sexual and reproductive health (SRH) concerns. As subspecialists often serve as primary care providers for those with chronic disease, this study examines pediatric SCD providers' practices and attitudes related to SRH of AYA women with SCD. Methods: We developed an adapted survey to identify SCD provider attitudes and practices in addressing menses, sexual activity, contraception, and pregnancy for their female patients. We electronically distributed this survey to the American Society of Pediatric Hematology/Oncology SCD interest group. We used descriptive statistics to analyze results. Results: A total of 78 pediatric SCD providers completed the survey. A majority (95%) rated SRH discussions as moderately important or higher, with 89% agreeing this care should be standardized. Most respondents reported discussing SRH, such as menses (78%), teratogenic medications (61%), and contraception (90%), with their female patients with SCD at least annually. Although most refer AYAs with SCD for birth control (83%), 39% endorsed a preferred method, with 33% of these favoring levonorgestrel intrauterine devices in this population and 40% injectable contraception. Approximately half of respondents (57%) reported that the use of combined hormonal contraceptives was unacceptable despite published guidelines that support potential benefits outweighing theoretical risk in AYAs with SCD. Conclusions: The range of SRH conversations and contraceptive recommendations for AYAs from pediatric SCD providers is broad. SCD providers and AYAs with SCD would benefit from improved evidence and educational resources related to contraception as well as coordinated SRH counseling.Item The role of anticipated regret and health beliefs in HPV vaccination intentions among young adults(Springer, 2016-06) Christy, Shannon M.; Winger, Joseph G.; Raffanello, Elizabeth W.; Halpern, Leslie F.; Danoff-Burg, Sharon; Mosher, Catherine E.; Department of Psychology, School of ScienceAlthough cognitions have predicted young adults' human papillomavirus (HPV) vaccine decision-making, emotion-based theories of healthcare decision-making suggest that anticipatory emotions may be more predictive. This study examined whether anticipated regret was associated with young adults' intentions to receive the HPV vaccine above and beyond the effects of commonly studied cognitions. Unvaccinated undergraduates (N = 233) completed a survey assessing Health Belief Model (HBM) variables (i.e., perceived severity of HPV-related diseases, perceived risk of developing these diseases, and perceived benefits of HPV vaccination), anticipatory emotions (i.e., anticipated regret if one were unvaccinated and later developed genital warts or HPV-related cancer), and HPV vaccine intentions. Anticipated regret was associated with HPV vaccine intentions above and beyond the effects of HBM variables among men. Among women, neither anticipated regret nor HBM variables showed consistent associations with HPV vaccine intentions. Findings suggest that anticipatory emotions should be considered when designing interventions to increase HPV vaccination among college men.Item Sexual and reproductive health considerations in the care of young adults with inflammatory bowel disease: A multidisciplinary conversation(Elsevier, 2023-12-07) Reed, Sydney; Bugwadia, Amy K.; Dave, Sneha; Wilson, Hannah E.; Ramesh, Prathikka; Michel, Hilary K.; Anatomy, Cell Biology and Physiology, School of MedicineThe effects of inflammatory bowel disease (IBD) and the medications used to treat it on sexual and reproductive health can be significant, impacting the quality of life of patients across gender identities. This article presents insights from a roundtable discussion facilitated by the Crohn's and Colitis Young Adults Network (CCYAN) between young adult patients with IBD and medical professionals, including physicians, nurses, psychologists, and trainees/medical students. It underscores the distinction between sexual and reproductive health, emphasizing the need to address both aspects comprehensively. The discussion identified key themes, including sexual dysfunction and well-being in IBD patients; discussing sexual health with young adult IBD patients; current research in reproductive health: gaps and opportunities; discussing reproductive health with young adult IBD patients; and providing resources and comprehensive multidisciplinary care.Item Sexual Function, Anxiety, Depression and Coping After Myocardial Infarction: An Exploratory Study(Springer, 2022) Smith, Asa B.; Davis, Matthew; Jackson, Elizabeth A.; Wittmann, Daniela; Smith, Jacqui; Barton, Debra L.; School of NursingBackground: Myocardial infarction (MI) may decrease sexual function and satisfaction in men and can be influenced by anxiety, depression, and sexual fear. However, few studies have examined short-term changes in sexual function over time in a post-MI population. This study aimed to longitudinally describe changes in sexual function and satisfaction in a sample of men post-MI. Methods: Eighteen patients were recruited from a Midwestern hospital. Surveys were mailed two weeks and three months post discharge. Sexual function was measured with the Male Sexual Function Index. Other variables collected included sexual fear (Multidimensional Sexuality Questionnaire), anxiety and depressive symptoms (Patient-Reported Outcomes Measurement Information System Anxiety and Depression 4a), and use of coping strategies (Coping Strategy Indicator). Results: Sexual function scores increased in the entire sample from 8.9 (SD 7.3) at two weeks to 14.6 (SD 8.9) at three months (18.8% improvement, p=0.04). Men who were sexually active improved their scores by 27.3% (p=0.01), while those who were not sexually active decreased their scores by 2.3% (p=0.5). Depressive symptoms and anxiety scores were low and largely stable across timepoints, though there were some improvements among men who were sexually active compared to those who were not. Decreased utilization of avoidance coping strategies was reported in sexually active versus inactive men. Conclusion: While sexual function improved within a short-time period post discharge among sexually active men post-MI, further research is needed with a larger sample to understand these changes across a longer period. Additional research is also warranted to examine any potential influence of psychosocial predictors.Item Telemedicine Use During the COVID-19 Pandemic in 8 Countries From the International Sexual Health and Reproductive Health Consortium: Web-Based Cross-Sectional Survey Study(JMIR, 2025-03-04) Tan, Rayner Kay Jin; Hensel, Devon; Ivanova, Olena; Bravo, Raquel Gomez; Olumide, Adesola; Adebayo, Emmanuel; Cleeve, Amanda; Gesselman, Amanda; Shah, Sonam Jyoti; Adesoba, Helen; Marley, Gifty; Tang, Weiming; Pediatrics, School of MedicineBackground: Telemedicine is an important way to fill in the access gap to in-person health care services during challenging times like pandemics. Objective: This study aimed to investigate the role that telemedicine played during the COVID-19 pandemic by multicountry comparison of the use of telemedicine prior to and during the pandemic. Methods: This study analyzes data from the second wave of the International Sexual Health and Reproductive Health study. This included data collected between April 2021 and July 2022 in 8 countries, including Armenia (n=296), Egypt (n=889), Germany (n=138), Moldova (n=311), Nigeria (n=205), Portugal (n=951), Singapore (n=13), and Spain (n=54). This study covered sociodemographics, sexual and reproductive health (SRH), and telemedicine use. Descriptive statistics and multilevel modeling were used to assess the factors influencing the use of telemedicine. Results: Overall, 2857 participants were recruited. Approximately 57.6% (n=1646) of participants had never used telemedicine prior to COVID-19 measures, while 45.9% (n=1311) of participants required health care but reported not using telemedicine services following the introduction of COVID-19 measures. In high-income countries, the most common mode reported was audio-based telemedicine services, with 283 (71.8%) and 417 (73.5%) participants doing so before and during COVID-19, respectively. This was followed by text-based telemedicine services, with 152 (38.6%) and 173 (30.5%) participants doing so before and during COVID-19, respectively. In low- to middle-income countries, many participants also reported using audio-based telemedicine services, with 288 (35.3%) and 237 (40.8%) participants doing so before and during COVID-19, respectively. This was followed by chat-based telemedicine services, with 265 (32.4%) and 217 (37.3%) participants doing so before and during COVID-19, respectively. Multilevel modeling revealed that those who were older (adjusted odds ratio [aOR] 0.99, 95% CI 0.99-1.00) and were in countries with a higher gross domestic product per capita (aOR 0.99, 95% CI 0.98-1.00) were less likely to have ever used telemedicine. Participants who were of male sex assigned at birth (aOR 0.79, 95% CI 0.65-0.96) were less likely to use telemedicine during the pandemic. Participants who perceived that they were worse off financially were more likely to have switched to telemedicine during COVID-19 (aOR 1.39, 95% CI 1.02-1.89) and were more likely to report having a poor or fair experience of telemedicine services (aOR 1.75, 95% CI 1.34-2.29). When sexual orientation was included in the model, nonheterosexual individuals were more likely to ever use telemedicine prior to COVID-19 (aOR 1.35, 95% CI 1.08-1.69), more likely to have used telemedicine during COVID-19 (aOR 1.58, 95% CI 1.24-2.02), and more likely to have switched to telemedicine during COVID-19 (aOR 1.55, 95% CI 1.09-2.21). Conclusions: Telemedicine played a key role in addressing health care needs during the COVID-19 pandemic. Age, sex, economic status, and sexual orientation influenced its use.Item Trauma-Informed Sex Positive Approaches to Sexual Pleasure(Taylor & Francis, 2021-09-24) Fava, Nicole M.; Fortenberry, J. Dennis; Pediatrics, School of MedicineThis paper develops a trauma-informed sex-positive framework as a public health, clinical, and research approach to sexual experience over the life course. The framework centers trauma-informed sex positivity as the linkage for sexual pleasure (along with sexual wellbeing and sexual health) to the social, cultural, and legal concepts of sexual justice. By providing a conceptual distinction of sexual pleasure from sexual wellbeing and sexual health, the framework improves clarity about how these constructs are related as well as provides possibilities for detailed operationalization in public health surveillance and in the new research.Item Using a Social Ecological Framework to Understand Healthy Relationships and Unintended Pregnancy Risk Among Youth in Rural Communities and Youth Engaged in Systems(2023-11) Imburgia, Teresa Marie; Zhang, Jianjun; Cote, Michelle L.; Hensel, Devon J.; Ott, Mary A.Nearly 75% of adolescent pregnancies are unintended, putting those adolescents at risk for long-term physical, social, and mental health outcomes. Youth who live in rural areas and youth with system involvement are at increased risk of unplanned pregnancies and births. We used the social ecological framework to investigate the following known risks for unplanned pregnancies: early sexual onset, contraception non-use, and dating violence. First, we examined the behaviors and attitudes associated with early sexual onset and the intention to delay sex in rural middle school youth. Being older, having less agency for sexual refusal, system involvement, and more parent communication were associated with having sex and planning to have sex. This highlights the importance of early, comprehensive, and trauma-informed pregnancy prevention programs for younger adolescents. Second, we examined the impact of positive youth development (PYD) on the use of effective contraceptives for sexually active youth who are system involved. Only 13.9% used condoms alone and 41.5% hormonal contraception (+/- condoms) in the past three months. Multivariate ordinal logistic regression revealed that older age, female gender, and higher PYD skills were associated with the use of more effective contraceptives. The final study identified risk and protective factors for perpetration and victimization of dating violence among youth with system involvement. We observed high rates of dating violence across all participants, and gender differences in perpetration and victimization. Using Poisson regression models, both perpetration and victimization were related to higher levels of trauma, lower healthy relationship scores, having recent sex, and being a sexual minority. These studies indicate a need for early delivery of pregnancy prevention programs and services for higher risk youth that are trauma informed, sexually inclusive, and promote PYD and healthy relationships.