Associations Between Social Determinants of Health and Adolescent Contraceptive Use: An Analysis From the National Survey of Family Growth.

This research assessed social determinants of contraceptive use among a nationally representative sample of adolescents. This study analyzed nationally representative, publicly available data from the 2013-2015 National Survey of Family Growth (NSFG). The sample consisted of sexually active males and females between the ages of 15 and 19 (n = 775). Independent variables were social determinant questions asked on the NSFG, selected based on the Healthy People Social Determinants of Health Framework. We tested associations between adolescents' social determinants of health and 2 outcomes, use of any contraceptive at last sex, and effectiveness level of contraceptive method at last sex. Results indicated high contraceptive use at last intercourse (91.5%) and a significant association between any use of contraceptive and family structure (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI] = 1.04-4.03), employment (AOR = 2.00, 95% CI = 1.06-3.77), and education (AOR = 3.43, 95% CI = 1.06-11.13). Few participants reported use of a highly effective method of pregnancy prevention (4.3%). In regression analyses, access to health care (AOR = 0.34, 95% CI = 0.14-0.84) and language and literacy (AOR = 2.92, 95% CI = 1.03-8.26) were found to be associated with using moderately effective contraceptive method to prevent pregnancy compared with not using any method. Although adolescents report overall high rates of contraceptive use, not all contraceptives have the same rates of effectiveness, and adolescents are often choosing those with lower effectiveness. This study found low rates of highly effective contraceptives to prevent pregnancy use (ie, intrauterine device and implant). It is also important to further explore the associations between family structure (measured in this study as intact childhood family) and distal links to contraceptive use. Future research should also further distinguish pathways to adolescent decision-making to use contraceptive methods to protect against STIs and pregnancy.

The Connection Between Social Determinants of Health and Human Papillomavirus Testing Knowledge Among Women in the USA.

Human papillomavirus (HPV) causes 99% of cervical cancers. In the USA, HPV testing has recently been recommended as a stand-alone option for cervical cancer screening in women over 30 years of age. Yet, studies have shown low awareness of HPV testing. This study examines awareness and knowledge that US women possess regarding HPV testing using the social determinants of health (SDOH) framework. Women aged 30 to 65 years, without hysterectomy, completed an online survey (N = 812). The outcome variables included HPV testing awareness and HPV testing knowledge, a six-item validated scale. Predictor variables included three domains of the Healthy People 2020 SDOH framework: economic stability, education, and health and healthcare. Other important sociodemographic predictors were also included. Multiple logistic and linear regression identified variables associated with HPV testing awareness and knowledge, respectively. 62.4% of the women were aware of HPV testing, and the mean knowledge score was 2.8 (out of 6). Lower awareness and knowledge were observed in older women compared with younger women and among women who had either not received HPV vaccination or were unsure of their vaccination status. Higher education attainment was associated with greater awareness and knowledge. Also, women who had a well-woman visit in the last year had better knowledge. Findings from the study can be used to develop targeted prevention strategies and initiatives to improve HPV testing awareness and knowledge to help women make more informed health decisions and promote uptake of this screening tool.

Interventions using mHealth strategies to improve screening rates of cervical cancer: A scoping review.

MHealth interventions are extensively used to inform and remind women about cervical cancer and their upcoming screening appointments. Our scoping review aims to examine the effectiveness these interventions targeted to increase the uptake of cervical cancer screening along with its barriers and facilitators. We searched 4 databases (PsycINFO. PUBMED, CINAHL, and MEDLINE) for studies that were published between January 1, 2009 and October 2019. References were further screened manually for additional papers. Studies were included in the review if they used interventions including phone calls, text messages and mobile applications as their primary strategy to contact women. We identified 12 unique studies that met the inclusion criteria; seven were international studies. Most studies sent multiple messages (informative and reminder) and/or made numerous phone calls (manual/automated) to inform participants about cervical cancer screening, their nearest screening clinic, and their upcoming appointments. Five studies documented a significant increase in the uptake of cervical cancer screenings during the follow-ups conducted within 12 months. Qualitative studies suggested participants prefer particular communication mediums, and they were concerned about privacy and confidentiality issues when text messages were sent with their health information. Findings suggest mHealth interventions may be an effective strategy to reach women for improving their cervical cancer uptake. Barriers including transportation cost, inaccessibility, and inability to come for walk-in appointments in the health clinics need to be addressed, beyond reminders, in mobile phone-based interventions to facilitate their presence in their next appointment.

Gay and Bisexual Men in the US Lack Basic Information About Anal Cancer.

OBJECTIVE: The purpose of this study was to assess knowledge of human papillomavirus (HPV) as a cause of anal cancer among at-risk gay, bisexual, and other men who have sex with men (GBM). MATERIALS AND METHODS: Secondary analysis was conducted of cross-sectional data from 3 cycles of the Health Information National Trends Survey (2017, 2018, 2019). Results were reported for the subset of adults who identified as GBM (N = 212). Knowledge that HPV can cause anal cancer was the main outcome. Differences in knowledge were evaluated (using χ2 and multiple logistic regression) by demographic, health information factors, and access to care. RESULTS: Sixty-eight percent of GBM were aware of HPV. Knowledge that HPV causes anal cancer was low (<20%) in the overall sample and sample of GBM (17.9%; 95% CI = 11.0-24.7). Gay, bisexual, and other men who have sex with men were no more knowledgeable that HPV causes anal cancer than heterosexual men (14.8%; 95% CI = 12.9-16.9; p = .376). College-educated GBM had higher odds (adjusted odds ratio = 3.50; 95% CI = 1.02-11.97) of knowing HPV causes anal cancer than GBM with no college degree. No other factors were associated with knowledge. CONCLUSIONS: Gay, bisexual, and other men who have sex with men are largely unaware that HPV can cause anal cancer, despite high awareness of HPV itself. This is concerning given that GBM are at increased risk of HPV-associated anal cancer than the general population. Our findings suggest that information about anal cancer and health information about the benefits of HPV vaccination for anal cancer prevention are only reaching a small subset of college-educated GBM. Targeted anal cancer education programs are needed.

An Assessment of Cancer Education Needs to Promote Mid-Adult HPV Vaccination Among Male Sexual Minorities.

The purpose of this study was to assess behavioral expectations and related psychosocial factors regarding an age-expanded human papillomavirus (HPV) vaccine schedule among male sexual minorities (MSM). A measure of behavioral expectation (BE) ("How likely are you to get the HPV vaccine if the CDC recommendation was changed to include men older than 26?") was evaluated on an ethnoracially diverse sample (N = 318) of MSM. Sixty-seven percent would likely initiate vaccination if the recommendations change. Benefits of HPV vaccination were widely endorsed. Barriers/harms of vaccination were endorsed less frequently. Only 15.4% were concerned that the vaccine would not be effective. The main driver of BE was perceived physical benefits (R2 = 0.34). Psychological benefits were independently associated with BE but did not improve the explanatory model. Expectation of HPV vaccination is high among MSM in the expanded age range. Prevention of anogenital warts and anal cancer is an important consideration for this population; however, promoting the benefits of vaccination must be done in accordance with realistic expectations of vaccine efficacy in older sexually active MSM.

Associations Between Depressive Symptoms and Religiosity in Young Adults.

The purpose of this study was to evaluate the association between religiosity and depressive symptoms among young adults, as well as determine whether possession of parental assets influences the relationship between religiosity and depressive symptoms. Young adults (n = 775) from universities in the southwest were sent an online survey, evaluating depressive symptoms, religiosity beliefs, and the protective assets of the relationships with their mother and father. With regard to young adult depressive symptoms, results showed a significant inverse association with levels of organizational religious activities (OR range = 0.208-0.555), levels of non-organizational religious activities (OR range = 0.282-0.399), and intrinsic religiosity (OR range = 0.216-0.489). Overall, religiosity beliefs and practices appeared to be associated with fewer depressive symptoms. Inclusion of religious/spirituality-oriented strategies may be important for mental health interventions in emerging adulthood.

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.

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.

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.

A Qualitative Analysis of Access to Healthcare Among African American Adults in South Carolina.

Access to healthcare is a Social Determinant of Health that is associated with public health outcomes and barriers to access disproportionately affect African American adults. This study used a health and financial literacy approach to qualitatively assess how African American adults access healthcare and potential barriers faced (n = 20). Results indicated a wide range of experiences generally split between positive and negative experiences in access to healthcare. Specific themes that emerged included scheduling issues and appointment availability, expense of care, lack of transparency in insurance coverage, the need for more primary care clinics and enhanced community outreach and education on how to access healthcare. This research identifies a need for increased education surrounding health insurance coverage and an identified need for more local physicians or ease of scheduling. All participants in this study stated they were covered by health insurance of some form. Future research should examine these issues in the context of socioeconomic and insurance status.

"Do you want a period?" Launching and evaluating a brief contraceptive decision-making educational intervention.

OBJECTIVE: Do you want a period? empowers people who menstruate to better understand their reproductive health and contraceptive choices through informed patient-centered contraceptive decision-making. METHODS: Researchers partnered with the WISE (Women in the South-East) Telehealth Network to design, implement and evaluate the Do you want a period? brief educational intervention. Participants completed a longitudinal research study, including a web-based survey at baseline and a mobile-optimized text-based survey up to 6 weeks following baseline. RESULTS: Do you want a period? was believable (93%, n = 79), informative (89%, n = 76), and helpful (85%, n = 72). Participants who reported that the intervention was helpful were significantly more likely to be satisfied with the usefulness of information provided (OR 5.61 [95% CI 1.65-19.12]), the overall quality of services (OR 3.39 [95% CI 1.04-11.08)], and obtaining necessary medical care (OR 2.40 [95% CI 1.08-5.33)]. At longitudinal follow-up, participants who received contraceptive services reported high acceptability of intervention (4.51 (±0.53) out of 5). CONCLUSIONS: Do you want a period? envisions a new dialogue between women and clinicians, family, and friends. This brief educational intervention supports people who menstruate to determine if a safe and effective tailored contraceptive regimen is right for them.

Human papillomavirus (HPV) knowledge, beliefs, and vaccine uptake among United States and international college students.

Objective: The purpose of this study was to compare knowledge about human papillomavirus (HPV) and HPV vaccine, college student's beliefs toward HPV, and HPV vaccine uptake between US and international college students studying in the US. Participants: The study was conducted using a sample (N = 588) of college students from a university in the South Central US. Methods: Study measures was derived from previously validated measures. Data were collected via an online survey using Qualtrics. Results: Significant differences were found in HPV awareness, HPV vaccine awareness, and HPV vaccine uptake between US and international college students. Conclusion: This study showed existing disparities between US and international college students regarding HPV and HPV vaccine awareness, and HPV vaccine uptake. College health centers can play a crucial role in raising awareness of HPV and HPV vaccination rates by organizing various intervention programs to reduce these disparities.

Evaluation of a media literacy education program for sexual health promotion in older adolescents implemented in Southern universities.

OBJECTIVE: This study evaluated a media literacy education program designed for sexual health promotion, Media Aware, in southeastern universities. PARTICIPANTS: Participants included college students from four universities in the southeastern United States (n = 457). METHODS: Media Aware was implemented on college campuses either in a group setting, one-on-one setting, at a student event, or online only. Media Aware contains four sections on sexual health promotion including on how media messages influence sexual health, gender stereotypes and representations of romantic relationships, sexual violence, substance use, consent, sexual risk behaviors, contraception, STIs, and partner communication. RESULTS: Results indicated significant changes in intention to visit a healthcare provider for sexual health services, intention to use condoms and other forms of birth control, and awareness of Long Acting Reversible Contraceptives after participation in Media Aware. CONCLUSION: Future research should explore how to extend program impacts and use an experimental study design to assess between group differences.

Risk Factors for Sexual Violence Among College Students in Dating Relationships: An Ecological Approach.

College students in dating relationships are vulnerable to sexual violence given that nine out of 10 acts of sexual violence are perpetrated by acquaintances, friends, or dating partners. Although past research has explored the risk factors for sexual violence, few studies have considered multileveled factors associated with sexual violence. This study uses the ecological model to investigate the risk factors for sexual violence among college students in dating relationships. Domains of individual, interpersonal, community, and societal levels were examined for their associations with sexual victimization. A prevalidated survey was conducted among 361 undergraduates in dating relationships from a public university in the south central United States. Chi-square tests and negative binomial regression analysis were conducted. Approximately 35% of the college students reported experiencing some form of sexual violence perpetrated by their dating partner including attempted and completed rapes. College women reported having experienced significantly higher rates of sexual violence in comparison with college men. On the contrary, this study documents the significant higher prevalence of sexual violence among heterosexual students than among lesbian, gay, bisexual, transgender, queer college students for experiencing at least one type of sexual violence or unwanted sexual contacts in a dating relationship. Sexual victimization is associated with gender, sexual assertiveness, the frequency of hookups, peer deviance, parental involvement, and perceived discrimination. Participants' gender, frequent hookups, and lower sexual assertiveness are positively associated with risk of sexual victimization across all types of sexual violence. Multilevel prevention programs and strategies are needed on campuses to reduce sexual victimization among college students in dating relationships.

Utilizing Social Determinants of Health to Elicit Perceived Control Beliefs About Physical Activity Among African Americans.

This qualitative study explored African Americans' perceived behavioral control (PBC) beliefs about how social determinants of health (SDoH) impact their physical activity behavior. Thirty semi-structured interviews were conducted with African Americans aged 30-50 in Oklahoma. Interviews were audio recorded, transcribed, coded, and analyzed for themes by two independent coders. Economic stability themes represented beliefs that financial status facilitates physical activity, yet, employment duties impede physical activity. SES barriers to physical activity did not emerge within this relatively high SES sample. Neighborhood and built environment themes represented beliefs that accessibility facilitates physical activity, while inclement weather impedes physical activity. Although not a part of the question path, motivation emerged as a theme and represented beliefs about how motivation impacts physically active behavior in the absence of other SDoH barriers. This research can inform interventions developed to promote physical activity among African American adults in the central US.

Awareness and knowledge of HPV and HPV vaccination among adults ages 27-45 years.

OBJECTIVE: Recent guidelines indicate adults 27-45 years old can receive the human papillomavirus (HPV) vaccine based on a shared-decision with their healthcare provider. With this expansion in recommendations, there is a need to examine the awareness and knowledge of HPV and HPV vaccination among this age group for cancer prevention. METHODS: HINTS-5 Cycle-2 is a national survey of US adults, and was restricted to a complete case analysis of adults ages 27-45 years (N = 725). Sociodemographic, healthcare, and health information correlates were assessed for the outcomes of HPV awareness, HPV vaccine awareness, knowledge of HPV and cervical cancer, and knowledge of HPV and non-cervical cancers. Survey-weighted logistic regression models were conducted. RESULTS: Most respondents were aware of HPV (72.9%) and HPV vaccination (67.1%). Respondents were more likely to be aware of HPV and HPV vaccination if they were female, had a higher level of education, and had previous cancer information seeking behaviors. Although there was widespread knowledge of HPV as a cause of cervical cancer (79.6%), knowledge of HPV as a cause of non-cervical cancers was reported by a minority of respondents (36.1%). College education was positively associated with cervical cancer knowledge (aOR = 4.62; 95%CI: 1.81-11.78); however, no significant correlates were identified for non-cervical HPV associated cancer knowledge. CONCLUSION: While more than half of adults ages 27-45 years are aware of HPV and HPV vaccination, there are opportunities to improve awareness and knowledge, particularly related to non-cervical cancers, as these are critical first steps toward shared decision-making for HPV vaccination in mid-adulthood.

Social Determinants of Human Papillomavirus Vaccine Uptake: An Assessment of Publicly Available Data.

OBJECTIVES: Despite cancer prevention benefits associated with the human papillomavirus (HPV) vaccine, uptake in the United States is relatively low among males and females. Our objective was to use the Healthy People 2020 social determinants of health framework to determine the availability and characteristics of data on economic, educational, social, health care, and community factors affecting HPV vaccine uptake in the United States. METHODS: We included the most recent data sets from 6 publicly available, US-based, federally funded surveys that contained at least 1 measure of HPV vaccination among adolescents and young adults. We searched each data set for any social determinants of health measures within the 5 domains of the framework: economic stability, education, social and community context, health and health care, and neighborhood and built environment. RESULTS: The social determinants of health domains of education, economic stability, and health and health care appeared in all data sets. The domains of social and community context and neighborhood and built environment appeared in only 3 data sets. Even when domains were represented, we discovered gaps in the data sets, in which only limited measures of the social determinants were available. CONCLUSION: The addition of questions about the social determinants of health to the surveys that generate these data sets, particularly in the domains of social and community context and neighborhood and built environment, would strengthen the ability of public health researchers, policy makers, and professionals to identify associations between the social determinants of health and HPV vaccine uptake.

Modifiable Risk Factors and Readiness to Change among Homeless Adults.

Objectives: In this study, we examined the prevalence of modifiable health risk factors (eg, smoking, unsafe sexual practices, at-risk drinking, low fruit/vegetable consumption, inadequate physical activity, and overweight/obesity) and readiness to change among homeless adults in Oklahoma City, OK. A secondary aim was to examine the relationship between self-rated health and readiness to change. Methods: We examined readiness to change using "ladder of change" variables. We used linear regression models to predict self-rated health and readiness to change. Results: Participants (N = 581) were largely smokers (79%), consumed less than 5 fruit and vegetable servings per day (64%) and were overweight or obese (64%). Many participants were ready to change at-risk drinking (56%), fruit/vegetable consumption (74%), and overweight/obesity (74%). Regression analyses indicated that low fruit/vegetable consumption and physical activity were associated with lower self-rated health. Lower self-rated health was not significantly related to readiness to change any health risk factors. Conclusions: Among homeless adults, the prevalence of modifiable health risk factors was high, as was readiness to change. Research is needed to reduce individual risk factors in this understudied population.

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.