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BACKGROUND: Prebiopsy prostate-specific antigen density (PSAD) is a well-known predictor of clinically significant prostate cancer (csPCa). Since prostate-specific antigen (PSA) and prostate volume (PV) increase normally with aging, PSAD thresholds may vary. The purpose of the study was to determine if PSAD was predictive of csPCa in different age strata. METHODS: We retrospectively reviewed our institutional database for patients who underwent multiparametric magnetic resonance imaging (MRI) between January 2016 and December 2021. We included patients who had post-MRI prostate biopsies. Based on age, we divided our cohort into four subgroups (groups 1-4): <55, 55-64, 65-74, and ≥75 years old. PSAD accuracy was estimated by the area under the curve (AUC) as a predictive model for differentiating csPCa between the groups. CsPCa was defined as a Gleason Grade Group 2 or higher. Three different PSAD thresholds (0.1, 0.15, and 0.2) were tested across the groups for sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV). Chi-square and analysis of variance tests were used for bivariate analysis. All analys were completed using R 4.3 (R Core Team, 2023). RESULTS: Among 1913 patients, 883 (46.1%) had prostate biopsies. In groups 1, 2, 3, and 4, there were 62 (7%), 321 (36.4%), 404 (45.8%), and 96 (10.9%) patients, respectively. Median PSA was 5.6 (interquartile range 3.4-8.1), 6.2 (4.8-9), 6.8 (5.1-9.7), and 9 (5.6-13), respectively (p < 0.01). Median PV was 42.3 (30-62), 51 (36-77), 55.5 (38-85.9), and 59.3 (42-110) mL, respectively (p < 0.01). No difference was observed in median PSAD between age groups 1-4 (0.1 [0.07-0.16], 0.11 [0.08-0.18], 0.1 [0.07-0.19], and 0.1 [0.07-0.2]), respectively (p = 0.393). CsPCa was diagnosed in 241 (27.3%) patients, of which 10 (16.1%), 65 (20.2%), 121 (30%), and 45 (46.7%) were in groups 1-4, respectively (p < 0.001). For groups 1-4, the PSAD AUC for predicting csPCa was 0.75, 0.68, 0.71, and 0.74. While testing PSAD threshold of 0.15 across the different age groups (1-4), the PPV vs. NPV was 39.1 vs. 93.2, 33.6 vs. 87, 50.9 vs. 80.8, and 66.1 vs. 64.7, respectively. CONCLUSIONS: PSAD prediction model was found to be similar among different age groups. In young patients, PSAD had a high NPV but low PPV. With increasing age, the opposite trend was observed, likely due to higher disease prevalence. While PSAD thresholds may be less useful in older patients to rule out higher-grade prostate cancer, the clinical consequences of these diagnoses require a case-by-case evaluation.
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Valor Predictivo de las Pruebas , Antígeno Prostático Específico , Neoplasias de la Próstata , Humanos , Masculino , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico , Antígeno Prostático Específico/sangre , Anciano , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Edad , Próstata/patología , Próstata/diagnóstico por imagen , Clasificación del Tumor , Imágenes de Resonancia Magnética Multiparamétrica , Biopsia , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To compare the lifespan of first transcorporal cuff (TC) placement of an artificial urinary sphincter (AUS) versus standard placement (SP) in patients with prior radiotherapy (RT) for prostate cancer (PCa). METHODS: We reviewed first (virgin) AUS placements from two high-volume care centers between 1/2011 and 1/2021, including PCa patients with RT history. AUS lifespan was assessed via the hazard ratio of device explantation and/or revision within a ten-year timeframe for the TC vs. SP approaches. Chi-square, Fisher's exact, and t-tests compared clinicodemographic variables. Kaplan-Meier curve compared TC and SP lifespan. RESULTS: 85/314 men with AUS met inclusion criteria, with 38.8% (33/85) in the TC group and 61.2% (52/85) in the SP group. Median ages were 69.8 (IQR = 65.2-73.6) and 67.1 (61.6-72.9), respectively, p = 0.17. Over a median follow up of 51.9 (15.8-86.1) and 80.4 (28.1-128.3) months for the TC and SP, overall, 12 (36.4%) TC devices were removed (four [12.1%] due to mechanical failures; eight [24.2%] erosions, and two [6.1%] infections) vs. 29 (55.8%) in the SP group (14 [26.9%] mechanical failures; 11 [21.1%] erosions, and five [9.6%] infections). No statistically significant differences were observed between the two approaches, with HR = 0.717, 95% CI 0.37-1.44, p = 0.35. The calculated device survival probabilities for the TC vs. SP at one, five, and 10 years were 78.8% vs. 76.9%, 69.3% vs. 58.7%, and 62.1% vs. 46.7%, respectively. CONCLUSIONS: TC cuff insertion for the first AUS implantation in pre-radiated patients showed to be comparable to SP when it comes to device survival, with comparable complication rates. Current guidance for approach selection is primarily based on patient selection and surgeon preference.
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Neoplasias de la Próstata , Esfínter Urinario Artificial , Humanos , Masculino , Anciano , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Implantación de Prótesis/métodos , Factores de Tiempo , Falla de PrótesisRESUMEN
BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) is increasingly used for risk stratification and preoperative staging of prostate cancer. It remains unclear how Grade Group (GG) interacts with the ability of mpMRI to determine the presence of extraprostatic extension (EPE) on surgical pathology. METHODS: A retrospective review of a robotic assisted laparoscopic radical prostatectomy (RALP) database from 2016-2020 was performed. Radiology mpMRI reports by multiple attending radiologists and without clear standardization or quality control were retrospectively assessed for EPE findings and compared with surgical pathology reports. The data were stratified by biopsy-based GG and a multivariable cluster analysis was performed to incorporate additional preoperative variables (age at diagnosis, PSA, etc.). Hazard ratios were calculated to determine how mpMRI findings and radiographic EPE relate to positive surgical margins. RESULTS: 289 patients underwent at least one mpMRI prior to RALP. Preoperative mpMRI demonstrated sensitivity of 39.3% and specificity of 88.8% for pathological EPE and had a negative predictive value (NPV) of 49.5%, and positive predictive value (PPV) of 84.0%. Stratification of NPV by GG yielded the following values: GG 1-5 (49.5%), GG 3-5 (40.8%), GG 4-5 (43.4%), and GG 5 (30.4%). Additionally, positive EPE on preoperative mpMRI was associated with a significantly decreased risk of positive surgical margins (RR: 0.655; 95% CI: 0.557-0.771). CONCLUSIONS: NPV of prostate mpMRI for EPE may be decreased for higher grade tumors. A detailed reference reading and image quality optimization may improve performance. However, urologists should exercise caution in nerve sparing approaches in these patients.
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Imágenes de Resonancia Magnética Multiparamétrica , Neoplasias de la Próstata , Masculino , Humanos , Imagen por Resonancia Magnética/métodos , Estudios Retrospectivos , Márgenes de Escisión , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/patología , ProstatectomíaRESUMEN
As menstrual product advertising evolves within the United States, it is important to understand how advertising messages, which have been shown to impact self-esteem and feelings of shame, may be influencing young people today. We analyzed menstrual product advertising over ten years (2008-2018) through a survey (n = 198) and focus groups (n = 21) with college and graduate student-aged adults. Three themes emerged: an emphasis on femininity and shame; the presence and role of men in the menstrual process; and racial, gender and body type inclusivity. Advertising shifts toward messages of inclusivity may positively influence young people's perceptions toward their bodies and menstruation.
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Publicidad , Productos para la Higiene Menstrual , Femenino , Masculino , Adulto , Humanos , Estados Unidos , Adolescente , Persona de Mediana Edad , Menstruación , Identidad de Género , AutoimagenRESUMEN
Sexual assault is a major concern on college campuses. Some colleges and universities adopt and educate their students using an affirmative consent standard, such that for a sexual encounter to be considered consensual (and thus not an act of sexual assault), it must include explicit, voluntary, and conscious agreement to engage in sexual activity by all parties involved. The current study sought to examine the extent to which accurate knowledge and understanding of affirmative sexual consent may explain college students' intentions to engage in affirmative sexual consent communication, alongside other influential predictors, as proposed by the Integrated Behavioral Model. Results indicated that while college students who were more likely to define sexual consent based upon an affirmative consent definition were also more likely to intend to engage in affirmative sexual consent communication, it was ultimately the ability to apply that knowledge to a variety of sexual situations that predicted behavioral intentions, alongside positive attitudes about and perceived behavioral control to engage in the behavior. Colleges and universities must therefore not only inform their students about the definition of affirmative sexual consent, they must also provide them with situational knowledge about how and when to engage in affirmative sexual consent communication, as well as improve students' related attitudes and perceived behavioral control.
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Comunicación , Delitos Sexuales/prevención & control , Conducta Sexual/psicología , Estudiantes/psicología , Femenino , Humanos , Masculino , Estudiantes/estadística & datos numéricos , Estados Unidos , Universidades , Adulto JovenRESUMEN
Human papillomavirus (HPV) vaccination is routinely recommended for U.S. adolescents ages 11 to 12 years, yet vaccine coverage remains low. Text message HPV immunization reminders to parents have been effective with increasing uptake, but text messages directly to adolescents in order to increase HPV vaccination uptake are unknown. The purpose of this study was to examine the acceptability of text messages about HPV vaccination and message preferences among adolescents. Middle school students (n = 43) assisted in designing text messages to promote HPV vaccine among their peers. Through seven focus groups and two in-class surveys, we assessed students' knowledge of HPV vaccine, use of texting, and preferences for text messages and sources. The average age of participants was 13 years, and all were White (17 males, 26 females) in this rural setting. More than 70% used text messaging with a cell phone. The text message with the best composite score (M = 2.33, SD = 0.72) for likeability, trustworthiness, and motivation to seek more information was a gain frame emphasizing reduction in HPV infection if vaccinated against HPV. Text messages with lower scores emphasized threats of disease if not vaccinated. Participants (68%) preferred doctors as their information source. Text messaging to adolescents may be a strategy to improve HPV knowledge and vaccination.
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Conocimientos, Actitudes y Práctica en Salud , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Sistemas Recordatorios/instrumentación , Envío de Mensajes de Texto , Adolescente , Niño , Femenino , Promoción de la Salud/métodos , Humanos , Masculino , Motivación , Estados UnidosRESUMEN
OBJECTIVE: To explore the optimal timing for placing an artificial urinary sphincter (AUS) postradiation therapy (RT). METHODS: A bi-institutional retrospective review of all patients who underwent their first (virgin) AUS placement after pelvic RT between January 1, 2011 and July 1, 2023. To determine the optimal timeline for device implantation 2-5years post-RT, we compared hazard ratios for device revision/explantation (Rev/Exp) using Kaplan-Meier curves for each year (earlier vs later than 2/3/4/5 years post-RT). The Pearson correlation coefficient identified trends in Rev/Exp reasons (erosion/infection vs other). RESULTS: Seventy-two patients met our inclusion criteria with a median age of 65.5years (interquartile range 70-81.25). Fifteen (20.8%) had undergone one or more previous urethral or bladder neck interventions (urethroplasty in 1 [1.4%], internal urethrotomy in 7 [9.7%], and bladder neck incision in 9 [12.5%]). After a median follow-up of 57.5months (interquartile range 13-107), a total of 36 (50%) devices were Rev/Exp, with mechanical failure in 14 (19.4%) and device erosion in 12 (16.7%) being the main reasons. Device survival analysis revealed no significant difference in the risk of device Rev/Exp when implanted earlier vs later than 2, 3, 4, or 5years post-RT, with P-values of .3, .3, .4, and .4, respectively. A constant trend toward higher infection/erosion rates as indication for device Rev/Exp the later the insertion was noticed: R2 = 0.98. CONCLUSION: Despite a small sample size, our study indicates that implanting an AUS within 5 years after RT shows comparable device lifespan. However, later insertions may have higher removal rates due to erosion/infection. CLINICAL TRIAL REGISTRATION: Not applicable.
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The HPV vaccine is approved for children as young as age nine and recommended by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices routinely for ages 11-12. However, many U.S. adolescents do not complete the vaccine series until middle to late adolescence, if at all, leaving them vulnerable to future HPV infection and attributable cancers. Health disparities exist for both vaccination coverage and most HPV-associated cancers. A strategy for improving vaccination rates for all populations and reducing disparate gaps in protection and health disparities from HPV-associated cancers is to shift the routine recommendation to an earlier age, that is, to start the vaccine series at age nine instead of ages 11-12. Challenges, opportunities, and suggestions for communicating this recommendation are outlined alongside considerations of social determinants of health.
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Neoplasias , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Adolescente , Niño , Humanos , Vacunación , Cobertura de VacunaciónRESUMEN
OBJECTIVE: To evaluate the involvement of women surgeons in RLS over time and across fields. While women are an increasing proportion of the urological workforce, the overall percentage of women urologists remains low. As robotic/laparoscopic surgery (RLS) has become first-line for many surgical problems, we hypothesized that women in urology may have lower participation than other specialties. MATERIALS AND METHODS: We obtained country-wide data by surgeon from the Data.CMS.gov database for 2014-2019 for major RLS procedures in colorectal surgery, gynecology, thoracic surgery, and urology. Data were sorted by gender and CPT code. Temporal trends were assessed, and estimation was performed by exponential regression comparing means and rates of change between departments and surgeon genders. RESULTS: Surgeons across disciplines and genders showed increases in RLS volume over time (P <.05). There were significant differences between men and women surgeons between specialties in average number of surgeons (P <.0001) and rate of change over time (Pâ¯=â¯.0035). The difference of the rate of increase in the number of surgeons performing RLS between genders was significant for all disciplines, suggesting women were entering RLS surgery faster than men across specialties (P <.05). CONCLUSION: There is a disparity in RLS procedure performance in men vs women across surgical disciplines. The greatest discrepancy in participation between genders existed in Urology, despite the field having a higher percentage of women physicians than other some subspecialties. Targeted action to address barriers to women surgeons' participation in RLS will increase diversity of thought and improve clinical care.
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Laparoscopía , Médicos Mujeres , Procedimientos Quirúrgicos Robotizados , Urología , Humanos , Masculino , Femenino , Factores Sexuales , UrólogosRESUMEN
This study examined how U.S. partisans (N = 1,154) may engage in greater victim blaming and sexual assault myth acceptance to defend their political identities in the #MeToo era. The more Republicans and Democrats identified with being a member of their political party and reported feeling defensive when members from their political party are criticized, the more accepting they were of common sexual assault myths and thus the less likely they were to perceive sexual assault as a serious issue in need of addressing and the #MeToo movement as having a positive impact in the United States.
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Víctimas de Crimen , Violación , Delitos Sexuales , Emociones , Humanos , Identificación Social , Estados UnidosRESUMEN
OBJECTIVES: To evaluate the use of direct oral anticoagulants following radical cystectomy for venous thromboembolism prophylaxis. We compared the experience of those who received venous thromboembolism prophylaxis following a robot-assisted radical cystectomy with either a direct oral anticoagulant or enoxaparin. METHODS: Medical records of 66 patients who underwent robot-assisted radical cystectomy between July 2017 and May 2020 at a single academic institution were reviewed retrospectively. Patients received extended prophylaxis with either a direct oral anticoagulant or enoxaparin before or following surgical discharge. Venous thromboembolic events and complications resulting in emergency department visits and readmissions were reviewed over a 90-day postoperative period. RESULTS: A total of 4 venous thromboembolic events within 90 days of surgery were observed. Among patients taking enoxaparin, 5% (2/37) developed a deep vein thrombosis and 3% (1/37) developed a pulmonary embolism. Among patients taking direct oral anticoagulants, 3% (1/29) developed a deep vein thrombosis. Zero patients in the enoxaparin group and 3% (1/29) of patients in the direct oral anticoagulant group experienced bleeding that required an emergency department visit. CONCLUSION: Direct oral anticoagulants performed comparably to enoxaparin in this feasibility study following robot-assisted radical cystectomy in 66 patients. No significant differences in the number of venous thromboembolisms or bleeding complications were observed. These data encourage future studies and support the prospect of direct oral anticoagulants as a potentially suitable oral alternative to injectable low molecular weight heparins for venous thromboembolism prophylaxis following radical cystectomy.
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Antitrombinas , Quimioprevención , Cistectomía/efectos adversos , Enoxaparina , Hemorragia , Procedimientos Quirúrgicos Robotizados/efectos adversos , Tromboembolia Venosa , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Antitrombinas/administración & dosificación , Antitrombinas/efectos adversos , Quimioprevención/efectos adversos , Quimioprevención/métodos , Cistectomía/métodos , Enoxaparina/administración & dosificación , Enoxaparina/efectos adversos , Femenino , Hemorragia/inducido químicamente , Hemorragia/prevención & control , Hemorragia/terapia , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Estudios Retrospectivos , Ajuste de Riesgo/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & controlRESUMEN
This article summarizes the findings from a systematic literature review to examine how social media may impact HPV vaccine uptake and HPV and HPV vaccine related awareness, knowledge, and attitudes. Study inclusion criteria was original data collection of at least one data point about social media and HPV and/or HPV vaccination, such that the study provided insight into how social media content may influence HPV and HPV vaccine related knowledge, attitudes, and/or behaviors. A total of 44 relevant articles were identified using the following databases: PubMed, PsycINFO, Communication Source, Sociological Abstracts, Business Source Elite, and the Educational Resources Information Center (ERIC). Most studies analyzed the valence, type, and frequency of social media content about HPV vaccination, and some found associations between potential exposure to negative, anti-vacc`11qine content and lower vaccination rates. Some studies that included primary human subject data collection found that engagement with HPV related social media content was associated with improved awareness and knowledge but not with increased vaccine uptake. The literature overall is lacking in systematic and rigorous research examining the effects of social media on HPV related knowledge, attitudes, and behaviors and needs further examination as social media increasingly becomes a source of health information.
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Terapia Conductista/métodos , Educación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Vacunas contra Papillomavirus/administración & dosificación , Medios de Comunicación Sociales , Cobertura de Vacunación/estadística & datos numéricos , Adolescente , Adulto , Niño , Femenino , Humanos , Infecciones por Papillomavirus/prevención & control , Adulto JovenRESUMEN
ABSTRACT Background: Multiparametric magnetic resonance imaging (mpMRI) is increasingly used for risk stratification and preoperative staging of prostate cancer. It remains unclear how Grade Group (GG) interacts with the ability of mpMRI to determine the presence of extraprostatic extension (EPE) on surgical pathology. Methods: A retrospective review of a robotic assisted laparoscopic radical prostatectomy (RALP) database from 2016-2020 was performed. Radiology mpMRI reports by multiple attending radiologists and without clear standardization or quality control were retrospectively assessed for EPE findings and compared with surgical pathology reports. The data were stratified by biopsy-based GG and a multivariable cluster analysis was performed to incorporate additional preoperative variables (age at diagnosis, PSA, etc.). Hazard ratios were calculated to determine how mpMRI findings and radiographic EPE relate to positive surgical margins. Results: Two hundred and eighty nine patients underwent at least one mpMRI prior to RALP. Preoperative mpMRI demonstrated sensitivity of 39.3% and specificity of 88.8% for pathological EPE and had a negative predictive value (NPV) of 49.5%, and positive predictive value (PPV) of 84.0%. Stratification of NPV by GG yielded the following values: GG 1-5 (49.5%), GG 3-5 (40.8%), GG 4-5 (43.4%), and GG 5 (30.4%). Additionally, positive EPE on preoperative mpMRI was associated with a significantly decreased risk of positive surgical margins (RR: 0.655; 95% CI: 0.557-0.771). Conclusions: NPV of prostate mpMRI for EPE may be decreased for higher grade tumors. A detailed reference reading and image quality optimization may improve performance. However, urologists should exercise caution in nerve sparing approaches in these patients.
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OBJECTIVE: To test the effectiveness of a college student-driven sexual consent education campaign to improve college students' sexual consent understanding. PARTICIPANTS: Undergraduate students (N = 992) at a large, public Midwestern university between March and December 2015. METHODS: Three online survey questionnaires assessing relevant outcome measures were distributed to the university's undergraduate student population before, during, and after the campaign's implementation over two consecutive academic semesters. RESULTS: Exposure to the campaign and the sexual consent understanding of the student population improved over time. College men and members of university-affiliated social sororities or fraternities resulted in greater improvement than their respective counterparts (i.e., college women, nonmembers). CONCLUSIONS: Sexual consent education campaigns for college students that are student-driven and address relevant sociocultural factors while authentically interacting with students can improve students' sexual consent understanding. These type of campaigns also have the opportunity to reach historically hard-to-reach audiences, such as college men.
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Comunicación , Violencia de Pareja/prevención & control , Educación Sexual/organización & administración , Delitos Sexuales/prevención & control , Conducta Sexual/psicología , Estudiantes/psicología , Adulto , Femenino , Humanos , Relaciones Interpersonales , Masculino , Medio Oeste de Estados Unidos , Conducta Sexual/estadística & datos numéricos , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios , Universidades/estadística & datos numéricos , Adulto JovenRESUMEN
PURPOSE: A greater understanding of how college men's gendered beliefs and communication styles relate to their sexual consent attitudes and intentions is essential within the shifting context of negative to affirmative consent policies on college campuses. The results of this study can be used to help design more effective sexual consent interventions. METHODS: Three hundred seventy undergraduate college men completed cross-sectional online surveys. Hierarchical multiple regression examined how hypermasculinity, token resistance, rape myth acceptance, and sexual communication assertiveness were associated with consent-related attitudes, intentions, and interpretations. RESULTS: Bivariate correlations among all variables were significant. In multivariate analyses, sexual communication assertiveness was positively associated with all consent outcomes, and token resistance and rape myth acceptance were negatively associated with some. Hypermasculinity was not a significant factor. CONCLUSIONS: Programs seeking to improve sexual consent communication among college men should reduce destructive beliefs and encourage sexually assertive communication.
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Agresión/psicología , Asertividad , Comunicación , Masculinidad , Violación/psicología , Estudiantes/estadística & datos numéricos , Adulto , Estudios Transversales , Humanos , Internet , Masculino , Conducta Sexual , Encuestas y Cuestionarios , UniversidadesRESUMEN
This study describes the formative research, execution, and evaluation of a social media health intervention to improve adolescents' knowledge about and vaccination against human papillomavirus (HPV). Based on the results from formative focus groups with adolescents (N = 38) to determine intervention feasibility, parameters, and message preferences, we developed and conducted a pretest/posttest evaluation of a 3-month social media health intervention for adolescents who had not completed the HPV vaccine series (N = 108). Results revealed that adolescents who fully engaged with the intervention improved in their knowledge compared with a control group, and many were also likely to have interpersonal discussions with others about what they learned. Adolescents are generally interested in receiving information about HPV and the vaccine, along with other relevant health information, through social media channels if messages are considered interesting, their privacy is protected, and the source is credible.
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A large sample of entertainment television programs that aired on 28 channels in China in 2004 were analyzed for romantic and sexual content. Romantic scenes, typically portraying men and women already in committed relationships, appeared in 80 percent of the 196 programs analyzed. The analysis suggested that, according to Chinese television in the early part of the 21st Century, emotional love was more important than physical sexual interaction in romantic relationships. More than half of the 1,112 romantic scenes analyzed depicted love between the partners without any discussion or display of physical sexual behavior. Only eight percent of scenes included discussion or depiction of sexual behavior (e.g., touching, kissing, intercourse) without some sense that the partners were in a loving, committed relationship. Sexual intercourse was implied or depicted in fewer than two percent of the romantic scenes. Findings are discussed in light of the Chinese government's periodic regulation of sexually suggestive media content and attempts to filter Internet content. The extent to which such content may affect young viewers' perceptions of romantic relationships and sexual behavior is also discussed.