Ci3 Seeks Youth Ages 15-24 for Mobile App Dev – PAID

Mobile App development pic

Are you between the ages of 15-24 and interested in contraception, STI prevention and technology?

Ci3 is seeking young people to assist in the development of a mobile app to help youth make healthy decisions about contraception and STI prevention. Please contact Dr. Lucy Hebert at (773) 834-7196 or lhebert@bsd.uchicago.edu to confirm your spot.

  • What will I be doing? You will help to design a mobile app, by engaging in a series of group discussions focusing on pregnancy and STI prevention. We will lead every session, and all you have to do is come ready to participate. We even provide dinner!
  • What is the time commitment? You will participate in 8 sessions (dates TBA) over the next 2 years. Each session will last 1-2 hours.
  • Where will it take place? All sessions will be held at the Ci3 offices (1225 E. 60th St. on The University of Chicago campus in Hyde Park).
  • What do I get out of it? Over the course of 2 years, you will be compensated $300.

For more information, please contact Dr. Lucy Hebert at (773) 834-7196 or lhebert@bsd.uchicago.edu.

Contraception & STI Prevention: What Do Young African American Men Think?

This month, researchers from the Section of Family Planning & Contraceptive Research presented results of several ongoing studies at the North American Forum on Family Planning. Dr. Elisabeth Woodhams, now a physician at Thomas Jefferson University Hospital, discussed her findings from a focus group study that sought to understand African American adolescent males’ perceived responsibility for pregnancy prevention. Dr. Woodhams also received the award for the top presentation from an investigator in training.

Dr. Elisabeth Woodhams

Dr. Elisabeth Woodhams

Men, particularly young men, are often left out of conversations about how to improve contraception use, but male partners can have significant influence over the contraceptive and pregnancy decisions of their female partners. Several studies indicate that women are more likely to stick to a chosen method if their partners know they’re using it, or if the partner is involved in the decision to use that method. The reality of this influence drove Dr. Woodhams to wonder how the partners regard this responsibility. Her study included teenaged African American males enrolled in charter schools on Chicago’s South Side. Several compelling themes emerged in Dr. Woodhams’ findings. One theme throughout was that even though the young men reported feeling responsible for the outcome of an unplanned pregnancy, it did not mean they acted to prevent pregnancy.

Focus on condoms, lacking knowledge of non-barrier methods

When asked about ways to prevent pregnancy, the most common answers were condoms, pull out, or don’t have sex. All had heard of pills, some had heard of IUDs or vaginal rings, and none knew about the contraceptive implant. Some had heard of Plan B, but often thought of it as a shot. Several quotes below reflect some of the misunderstandings about methods:

 “…I heard about one where you put it under a layer of skin in your arm. It’s called….Nuvaring.”

“She get the morning after shot and they’ll just kill all the sperm…”

“I also heard of that thing…they take the top off and put it in their vagina or whatever. Like it knock out, it blocks it. It works for years. It’s called… starts with ovulation.”

“All I heard is it goes inside them, but if you hitting it, if you playing bump around, you can knock it out of place.”

Primary role in sex was condom use and provision

Participants did know a lot about condoms, felt responsibility to provide and use a condom, and really only considered condom use when they talked about “protection.”

“…she like grabbin’ me…and just automatically stop and be like ‘you got the rubber?’ and I’m like ‘what?!’ … and most of the time I do because I always carry condoms like in my back pocket or something…”

“I take at least a third of the condoms… and I take ‘em to my girl crib. Cause I might come over there and then, you know, something might happen, I know that if I didn’t bring a condom I got somethin’ over there with her.”

STI prevention greatest motivator in condom use

STI prevention was the greatest motivator for condom use and reflected attitudes about partners.

I’mma need some condoms ’cause. Like, it wasn’t the fear of me havin’ a baby as the fear of me catchin’ something.”

 “You still use a condom. I don’t know what she got.  No matter what. Like, a girl could be on birth control all her life.  She could be on the best birth control. I’m still not gon’ go in raw.”

“Even before you get down to the having sex part you should always ask a girl when the last time she got checked up.”

Partner type, access, and family indirectly impacts condom use

Motivation to use condoms in a specific sexual encounter was indirectly mediated by several things, the most notable being the “type” of girl they’re having sex with, access to condoms, and family influence. The vast majority of the conversations were actually about the various names and terms the teens had for the girls they have sex with. For instance, “thots” were considered “dirty girls” who sleep with anyone, are likely to have an STI, and are not worthy of respect. “Mains” are a more regular partner, although not necessarily a monogamous partner.  Young men behaved differently when they were with casual partners than when they were with more regular partners, who in general they spoke about with more modesty and respect. With regular partners they often would forgo condoms, but several guys mentioned going to get STI testing with their partners before they made that leap. They did not universally mention discussing pregnancy prevention, although some did.

“Mod: If the thot’s like ‘man, come on get down, but you can’t use nuttin’.” Resp: “If we don’t use it then we ain’t doin’ it. Point blank.” Mod: “Okay. But wit’ yo main you not that way.” Resp: “mmm-mmm [MEANING NO]“.

“But, when it comes to like fuckin’ thots …you don’t know who they be fuckin’, you don’t know what they got, so you always wanna be protected.”

Access was also an issue, both in terms of immediate access and terms of cost and availability. As one participant observed, “We in the basement, I know I ain’t got no condoms, they’re upstairs. I’m not about to go to the 3rd floor, leaving a thot downstairs.”

Finally, participants referred to the women in their family as motivators to protect themselves, more from STIs than from pregnancy. They generally felt comfortable telling their family they were having sex, and depended on their mothers/grandmothers/aunts to provide condoms.

 “Like when you first talk to yo’ moms about it, you don’t wanna tell her cause feel like somethin’ bad gon’ happen. But after you tell her it turns out different…she gonna force condoms on you because she don’t want her child to catch no disease…”

Responsible for pregnancy, but not prevention

While the participants did not prioritize pregnancy prevention, when asked directly whose job it is to prevent pregnancy they reported it was a shared responsibility. However, if pregnancy happened, it was mostly the young man’s fault, especially if they weren’t using a condom. They feared unplanned pregnancies and felt a very strong sense of responsibility if pregnancy happened – this often came out within the context of manhood. When they talked about unplanned pregnancy there was a sense of helplessness; they weren’t interested in fathering but there was little they could do about it aside from use condoms.

 “And I shoulda used a condom. And basically, I’mma have to like get two jobs and like I can’t like, I’mma have to finish school so I could get a better job and I’m not even ready yet.  And you thinkin’ all of this, and how your parents is gon’ react. And you havin’ a child. Like how that’s gon’ make you growin’ up so much faster and your life is basically through.”

 “With the guy he has to know that he has two options that he can take.  Face it like a man or basically run away.  Run away and then he has that title saying ‘you a coward, you’re not a man that gon’ step up to the challenge of taking care of a child.’  But if he stays there he knows that he has to be dedicated, committed, make a sacrifice in his life.”

Conclusions

Dr. Woodhams found the young men in the study were much more focused on STI prevention rather than pregnancy prevention, even though they would feel responsibility if a pregnancy occurred. The concern for STIs prompts condom use, but if they believe their partner is low-risk, they will also stop using condoms. Dr. Woodhams suggested that one approach would be to leverage awareness and comfort with condom use among these young men to emphasize that condoms can also be part of pregnancy prevention. While other contraceptive methods may be more effective, young men may respond more positively to education about a method they already use. In addition, Dr. Woodhams observed that the young men perceived their sexual relationships completely based on risk, rather than on the relationship they were in with their partner. In fact, they rarely referred to a relationship at all, but easily categorized the young women they were having sex with into “good” or “bad,” “clean” or “dirty.” She suggested that sex education programs work to emphasize healthy and fulfilling relationship-building and respect as a response to these attitudes and their influence on condom use.

HIV Testing in Variety of Clinical Settings

In Supporting the Integration of HIV Testing into Primary Care Settings, published in The American Journal of Public Health, authors Janet J. Myers, et al, examined the efforts of the US network of AIDS Education and Training Centers (AETCs) to increase HIV testing capacity across a variety of clinical settings.

Authors utilized quantitative process data from 8 regional AETCs from 2008 and 2009, along with qualitative program descriptions to demonstrate how AETC education helped providers integrate HIV testing into routine clinical care with the goals of being able to diagnosis an infection as early as possible and providing treatment.

When compared with other AETC training, results indicated that HIV testing training was generally longer and utilized a broader variety of strategies to educate more providers per training.  It was also found that educational trainings did provide a platform for providers to master comprehension of their primary care responsibility to address public health concerns through HIV testing.  These AETC efforts illustrate not only how integration of the principles of primary care and public health can be promoted through professional training, but how integral these skills are to comprehensive and well-rounded clinical care practice.

New Study Examines Association between DMPA (Depo shot) and STI Risk among Adolescents

In the article Depot Medroxyprogesterone Acetate Use is Not Associated with Risk of Incident Sexually Transmitted Infections Among Adolescent Women, published in the Journal of Adolescent Health, author Amy Romer and other researchers from the Section of Family Planning and Contraceptive Research investigated whether depot medroxyprogesterone acetate (DMPA) use is associated with an increased risk of sexually transmitted infections (STIs) in a group of healthy adolescents. The authors found no evidence that DMPA use increased risk of STIs, and the only factor significantly associated with increased risk was a greater number of sexual partners (odds ratio, range = 1.91-2.62)

Adolescent women aged 14–17 years (n = 342) were recruited from clinical sites in the United States between 1999 and 2005. They returned quarterly for interviews and STI testing. During alternating 3-month periods, participants also completed daily diaries of sexual behaviors and performed weekly vaginal self-obtained swabs to test for STIs. Data collected through 2009 (median follow-up length = 42.2 months) were analyzed.

In multivariable analysis, there were no significant associations between DMPA use in the current or previous 3-month period and incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis. The only factor significantly associated with an increased risk of contracting all three STIs was a greater number of sexual partners during the diary period.

The authors conclude that in this U.S.-based cohort of adolescent women, no evidence was found that DMPA use is associated with increased STI risk. Authors recommend that efforts to curb STI transmission among adolescents should focus on education about the reduced number of sexual partners.

Reshaping Adolescent Sexual Health through Story Telling and Games

In the article From Intervention to Invitation: Reshaping Adolescent Sexual Health through Story Telling and Games, published in the African Journal of Reproductive Health, authors Melissa Gilliam, et al, from the Section of Family Planning and Contraceptive Research reviewed Game Changer Chicago. This project aims to reframe and retool adolescent sexual health education to focus on inviting rather than intervening with youth, which encourages self-empowerment that catalyzes increased awareness and self-efficacy. In addition to describing the Section’s ongoing work with sexuality education, technology and gaming, the article explores the project’s potential for successful implementation among youth in Africa.

Youth in both Chicago and Nigeria face disproportionately high rates of mortality and morbidity due to poor sexual and reproductive health. Game Changer Chicago is an initiative that incorporates digital storytelling, new media, and game design to conduct workshops with youth around issues of sexuality and emotional health. The intervention’s international, interdisciplinary team designed a series of workshops for teens to tell their stories in digital, “transmedia” formats.

Due to the positive feedback from youth participants, and the project’s promising potential to reach a wide audience online, the authors conclude that the program can continue to be successfully utilized and expanded by teens and adolescent reproductive health advocates in both domestic and international settings.

Depo Not Associated with Risk of Incident STIs Among Teens

In Depot Medroxyprogesterone Acetate Use Is Not Associated with Risk of Incident Sexually Transmitted Infections Among Adolescent Women, published in the Journal of Adolescent Health, authors Amy Romer, et al, examines whether depot medroxyprogesterone acetate (DMPA) use is associated with an increased risk of acquisition of sexually transmitted infections (STIs) in a cohort of healthy adolescents, for whom prospective evidence is sparse.

Adolescent women aged 14–17 years (n = 342) were recruited from clinical sites in the United States between 1999 and 2005. They returned quarterly for interviews and STI testing and also completed daily diaries of sexual behaviors and performed weekly vaginal self-obtained swabs to test for STIs.

The authors found that, in multivariable analysis, there were no significant associations between DMPA use in the current or previous 3-month period and incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis. The number of total or unprotected sexual events during the diary period was not associated with the risk of STI. Older age was a protective factor for the development of Chlamydia trachomatis (odds ratio = .85; 95% confidence interval = .76–.96). The only factor significantly associated with an increased risk of contracting all three STIs was a greater number of sexual partners during the diary period (odds ratio, range = 1.91–2.62).

In this cohort, the authors found no evidence that DMPA use was associated with increased STI risk and recommended that efforts to curb STI transmission among adolescents should focus on education about the reduced number of sexual partners.

Rural Black Adolescents and Their Thoughts on STI Prevention

In A Qualitative Study of Rural, Black Adolescents Perspectives on Primary STD Prevention Strategies, published in Perspectives on Sexual and Reproductive Health, authors Aletha Y. Akers, et al, studied Black adolescents and how the five key strategies of primary STD prevention (abstinence, choosing low-risk partners, discussing partners‚ sexual history, using condoms consistently and not having multiple partners) might impact them.

Rural Black adolescents have an extremely high rate of both early sexual initiation and STDs — the highest in the nation. Researchers conducted a sample of 37 Black adolescents (20 female, 17 male) from two rural North Carolina counties where adolescents participated in focus groups that explored their understanding of how primary prevention strategies reduce STD transmission, the common barriers they encounter in trying to adopt these strategies and the risk reduction strategies that they employ.

Results indicated that the majority of adolescents understood how to reduce STD transmission, yet they still perceived sex as normal and abstinence as unlikely.  They also considered the remaining primary prevention strategies difficult to implement because these strategies depended on partner cooperation.  Instead, many adolescents reported using alternative strategies to reduce their STD risk.  These included such tactics as evaluating their partner’s sexual history and routine STD testing.

The authors concluded that while adolescents try to reduce their STD risk, many of their practices are ineffective. Promoting primary prevention strategies requires helping adolescents to identify opportunities to successfully employ these strategies.

HIV-infected Young Women Perceive Lower Risk for All STIs After HPV Vaccine

In Risk Perceptions After Human Papillomavirus Vaccination in HIV-Infected Adolescents and Young Adult Women, published in The Journal of Adolescent Health, authors Jessica A. Kahn, et al, examined human papillomavirus (HPV) risk perceptions and perceived risk of other sexually transmitted infections (STIs) to determine factors associated with these risk perceptions after HPV vaccination.

99 HIV-positive women ages 16-23 participted in a vaccine clinical trial where they received the HPV vaccination series.  Immediately after receiving the first vaccine dose, participants completed a confidential questionnaire that included three 5-item scales measuring perceived risk of HPV, perceived risk of other STIs, and need for safer sexual behaviors.

Results indicated that most participants perceived themselves to be at lower risk for HPV,  most perceived that they were not at lower risk for other STIs, and the vast majority reported that there was still a need for safer sexual behaviors after vaccination.  Further analysis indicated that knowledge about HPV and HPV vaccines was associated with perceived need for safer sexual behaviors.

Although almost all the young women in this study believed that safer sexual behaviors were still important after HPV vaccination, a subset believed they were at less risk for STIs other than HPV.  Educational interventions are needed to prevent misperceptions and promote healthy behaviors after vaccination.  This will lead to reduction of STIs in the population at large, as well as promote accurate knowledge about STIs.

Examining HPV Vaccine Series Completion among Adolescents

In Follow-up Analysis of Adolescents Partially Vaccinated Against Human Papillomavirus, published in The Journal of Adolescent Health, authors Amanda Dempsey, et al, evaluated factors associated with human papillomavirus (HPV) vaccination among a cohort of female adolescents previously identified as receiving only one or two doses of vaccine.

Little is known about whether females identified in cross-sectional studies as having received some, but not all, doses of HPV vaccine eventually complete the three-dose series. National studies indicate that human papillomavirus (HPV) vaccine use among adolescent females is significantly lower than national vaccine targets, with only 32% of 13–17-year-old girls having completed the three-dose series as of 2010. These issues raise questions about the actual impact of HPV vaccines on cervical cancer rates in the United States.

1,714 partially vaccinated female adolescents were enrolled in this study. Authors examined this cohort of partially vaccinated adolescents at initial HPV vaccination, as well as for an additional 15 months to determine patterns of vaccine utilization.  Approximately half (53%) of the incompletely vaccinated female adolescent in this study finished the three-dose series in the 15-month follow-up period. There was a wide range of dosing intervals ranging from 31 to 840 days between first and second doses and from 85 to 666 days between second and third doses.

Series completion was significantly more frequent among those who started with two, rather than one dose, suggesting that each dose in the series can pose a significant barrier to series completion. In addition, series completion was more common among whites and those with private health insurance than African Americans or those with public insurance. The authors conclude that interventions are needed to improve adolescent HPV vaccination rates, particularly among high-risk populations.

Juvenile Detention, Mental Health and STIs

In The Consequences of Juvenile Detention Reform for Mental Health and Sexually Transmitted Infection Screening Among Detained Youth, published in The Journal of Adolescent Health, authors Matthew C. Allsma, et al, sought to understand how diversion of low-risk youth from juvenile detention affected screening practices for detained youth.

Over 22 months, 2,532 detainees aged 13–18 years were screened for mental health issues and sexually transmitted infections. Data were compared before and after the beginning of diversion efforts through implementation of a Risk Assessment Instrument (RAI). During the study period, the implementation of diversion programming in Marion County led to a 30% reduction in the rate of detention. Younger age, Hispanic versus white race/ethnicity and less severe crime predicted reduced likelihood of detention.

Diversion programming led to the unintended consequence of detention center and medical staff being able to screen more detained youth. The authors suggest that a lowered detention census allowed staff to be more responsive and more detained youth received mental health and STI screening. The authors conclude:

Although the screening rate in the post-RAI group did increase, this increase in screening effect was primarily noted among youth detained < 5 days…, suggesting staff had an increased ability to screen youth with short detention stays. When the rate of screening was controlled by conducting a subanalysis of youth detained at least 5 days, positivity rates for mental health conditions remained the same, whereas positivity rates for STI increased for males.

The authors recommend future study of the possible unintended consequences of criminal justice initiatives on public health outcomes.