Impact of participation as a peer change agent on peer change agents themselves: a quantitative study of a peer-led, social media-based PrEP promotion intervention.

Despite the adoption of pre-exposure prophylaxis (PrEP) as a crucial HIV intervention, uptake remains suboptimal among men who have sex with men, a sexual minority group, due to barriers like cost and stigma. Peer change agents (PCAs) disseminate PrEP information within their social networks. This study explores the reciprocal effects of an online community-based participatory intervention on PCAs, focusing on their transformed PrEP uptake perceptions-leadership efficacy, social network dynamics, attitudes, perceived benefits and barriers and self-efficacy. Leveraging insights from the PrEP Chicago Study, our research addresses a key gap in community-based participatory interventions for PrEP uptake: the transformative experiences and perception shifts of PCAs involved in these interventions. We engaged 20 men who have sex with men, aged 18-45, as PCAs in a one-group pretest-posttest design intervention, which disseminated PrEP communications within their preferred online networks. We utilized the PrEP Chicago Study's 45 Likert items, tailored to reveal the PCAs' transformative potential. Data on PrEP uptake perceptions, sociodemographics and social media use were captured and analyzed using the Wilcoxon matched-pairs signed-rank test, a nonparametric method. PCAs demonstrated significant changes in their PrEP uptake perceptions, including leadership capacity, social network dynamics, attitudes toward PrEP, perceived benefits, barriers and self-efficacy. Our intervention highlights the reciprocal transformation PCAs undergo when disseminating PrEP information. This study adds a new dimension to community-based PrEP interventions and underscores the need for continued refinement of peer-led strategies to optimize the transformative potential of PCAs.

Unlearning and relearning sexuality: a qualitative exploration of The Sex Wrap, a sex education podcast.

BACKGROUND: Traditional school-based sexuality education has a myriad of problems with its successful delivery, including access to comprehensive sexuality curricula, access to trained facilitators, and community and parental fears. As an alternative form of sexuality education, The Sex Wrap podcast is released in weekly episodes of about 20-45min, providing listeners with diverse, evidence-based sexual health information. METHODS: Participants in a larger mixed-methods study evaluating The Sex Wrap were invited to participate in qualitative in-depth interviews to explore their experiences with sexuality education, including The Sex Wrap , and how they relate to information received through the podcast. Seventeen interviews were conducted with listeners of The Sex Wrap , aged 20-25years old. RESULTS: One core category and three axial codes were identified in the interview data. The core category is: sexuality education is an ongoing process that includes learning and unlearning. The three temporally related axial codes are: (1) experiences with formal and informal sexuality education (mostly negative) drove participants to seek more information about sex, (2) participants use The Sex Wrap as a way of exploring and personalising information about sexuality, and (3) participants equipped with comprehensive sexuality education are empowered to educate their peers. CONCLUSIONS: This study suggests that podcast-based interventions, such as The Sex Wrap , can play a key role in young people's process of sexuality education and should be considered for incorporation into other forms of sex education.

Posts, Likes, Shares, and DMs: A Qualitative Exploration of How Social Media Is Related to Sexual Agency in Young People.

It is well documented that social interactions have a crucial impact on all aspects of personal development for adolescents, however few studies have documented how social interactions affect a young person's sense of sexual agency. The aim of the current qualitative study was to examine young people's perceptions of their own sexual agency in relation to their social media attitudes and behaviors. Participants (n = 31) were recruited from a nonprofit organization and asked to complete a one-hour in-depth interview and a demographic survey. Using an inductive method, involving constant comparison, we identified four overarching themes: (a) Participants utilize different social media platforms for distinct purposes and are cognizant of each audience; (b) Based on past experiences, participants have negotiated and created their own rules of engagement for online behavior; (c) Participants have different expectations about how others should act online versus how they act in relation to flirty or sexual messages; (d) Participants were concerned about the authenticity of online identities and are aware of vulnerability in online interactions. Our results highlight the need for sexual health researchers to observe social network etiquette closely through the lens of autonomy and agency.

Social media's role in support networks among LGBTQ adolescents: a qualitative study.

Background Adolescents use social media more frequently than other age groups. Social media has been described as a safe environment for lesbian, gay, bisexual, transgender and queer and/or questioning (LGBTQ) adolescents. As part of mixed-methods research investigating the association between social networks and sexual agency, we present qualitative findings on how LGBTQ adolescents connect online to form support networks. Methods We recruited 30 adolescents aged 14-17years who identified as LGBTQ in terms of their gender or attraction in the longitudinal Social Networks and Agency Project. Semi-structured interviews were conducted online or face-to-face across Australia. Thematic analysis was used to explore perceptions and experiences of participants in relation to social media use and relationships. Results Two overarching themes were identified: LGBTQ adolescents use social media for identity, relationships and wellbeing support. Social media is not always free of discrimination for LGBTQ adolescents. Many LGBTQ participants joined Facebook groups to connect with LGBTQ peers. Facebook was considered a vital support for those with mental health concerns including suicidal ideation. Participants gave and received support from group members, which was considered useful for those feeling isolated or victimised. LGBTQ adolescents formed friendships, romantic relationships and gained information on sex, relationships, and sexual health from these groups. Participants described negative experiences including discrimination within Facebook groups, mismanaged groups and exposure to anti-LGBTQ sentiments. Conclusion Social media is an environment where LGBTQ adolescents can connect, educate and support each other, which may have beneficial effects for this marginalised group. There remain issues with social media including discrimination against and within LGBTQ communities.

Corrigendum to: Social media's role in support networks among LGBTQ adolescents: a qualitative study.

Background:Adolescents use social media more frequently than other age groups. Social media has been described as a safe environment for lesbian, gay, bisexual, transgender and queer and/or questioning (LGBTQ) adolescents. As part of mixed-methods research investigating the association between social networks and sexual agency, we present qualitative findings on how LGBTQ adolescents connect online to form support networks.Methods:We recruited 30 adolescents aged 14-17years who identified as LGBTQ in terms of their gender or attraction in the longitudinal Social Networks and Agency Project. Semi-structured interviews were conducted online or face-to-face across Australia. Thematic analysis was used to explore perceptions and experiences of participants in relation to social media use and relationships.Results:Two overarching themes were identified: LGBTQ adolescents use social media for identity, relationships and wellbeing support. Social media is not always free of discrimination for LGBTQ adolescents. Many LGBTQ participants joined Facebook groups to connect with LGBTQ peers. Facebook was considered a vital support for those with mental health concerns including suicidal ideation. Participants gave and received support from group members, which was considered useful for those feeling isolated or victimised. LGBTQ adolescents formed friendships, romantic relationships and gained information on sex, relationships, and sexual health from these groups. Participants described negative experiences including discrimination within Facebook groups, mismanaged groups and exposure to anti-LGBTQ sentiments.Conclusion:Social media is an environment where LGBTQ adolescents can connect, educate and support each other, which may have beneficial effects for this marginalised group. There remain issues with social media including discrimination against and within LGBTQ communities.

What adolescents think of relationship portrayals on social media: a qualitative study.

Background Understanding the factors influencing adolescents' relationship views is important because early romantic relationships often act as precursors for relationships in adulthood. This study sought to examine the types of relationship-focused content adolescents witness on social media and how they perceive its effect on their romantic relationship beliefs. METHODS: Sixteen semistructured interviews were conducted with Australian adolescents aged 16-19 years who were purposively sampled from a larger longitudinal study. Interview transcripts were analysed qualitatively using constructivist grounded theory. RESULTS: Participants described the types of romantic relationship portrayals they saw on social media, including relationship-focused trends like 'Relationship Goals' and 'Insta-Couples'. Participants explained their ability to identify incomplete and unrealistic relationship portrayals, as well as the pressure to share their relationships online in the same incomplete fashion. Views regarding the influence of social media were varied, but most believed social media relationship portrayals had some level of influence on young people's relationship views; some participants believed this occurred regardless of awareness of the incompleteness of the online portrayal. CONCLUSIONS: Although participant interview data revealed the pervasiveness of social media relationship portrayals, it also revealed the sophisticated capabilities of adolescents in critiquing online media portrayals.

Pertussis vaccination coverage among Australian women prior to childbirth in the cocooning era: a two-hospital, cross-sectional survey, 2010 to 2013.

BACKGROUND: Recent pertussis epidemics have triggered implementation of cocooning, involving caregiver vaccination to indirectly protecting susceptible infants. AIM: To determine patient, provider and setting factors associated with maternal pertussis booster vaccination (dTpa) within 5-10 years before childbirth. MATERIALS AND METHODS: Cross-sectional survey using Health Belief Model constructs among postpartum women in a tertiary referral centre and a private hospital in Sydney, Australia. RESULTS: Pertussis vaccination was current among 33.7% of the 2483 new mothers (0.5% vaccinated during pregnancy). Women were more likely to be vaccinated if they had heard of 'whooping cough' from a health professional (OR: 2.59, P < 0.001, 95% CI: 1.70-3.95), were recommended the vaccine (OR: 2.48, P < 0.00, 95% CI: 1.55-4.00), perceived pertussis as 'severe' for adults (OR: 1.21, p0.009, 95% CI: 1.05-1.39) and 'common' within their community (OR: 1.38, P < 0.001, 95% CI: 1.18-1.61). They more often agreed that it was their parental responsibility to be vaccinated (OR: 1.61, P = 0.002, 95% CI: 1.19-2.18), and this would help prevent their baby from contracting pertussis (OR: 1.22, P = 0.046, 95% CI: 1.00-1.47). Vaccinated women were less likely to report vaccination barriers: time constraints (OR: 0.75, P < 0.001, 95% CI: 0.66-0.85) and having safety concerns (OR: 0.80, P < 0.001, 95% CI: 0.69-0.92). Additionally, their partners reported three times higher uptake (76% vs 49%; P < 0.001; 95% CI: 2.66-3.85). CONCLUSIONS: Current pertussis vaccination in only one in every three postpartum participants may indicate insufficient coverage to protect newborns. Practitioners are instrumental in raising awareness and addressing vaccine concerns. Integrating vaccination into routine obstetric care, whether antenatally or postnatally, may minimise barriers.

HPV.edu study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents.

BACKGROUND: The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake. METHODS/DESIGN: HPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes. DISCUSSION: This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision). Less anxiety in adolescents will likely promote more efficient vaccination, which will be more acceptable to teachers, nurses and parents. Through these interventions, it is hoped that vaccination uptake will be increased. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry, ACTRN12614000404628 , 14.04.2014.

Understanding pregnant women's attitudes and behavior toward influenza and pertussis vaccination.

Internationally, pregnant and postpartum women have been the focus of influenza and pertussis immunization campaigns, with differing levels of vaccine acceptance. We used semistructured interviews to explore pregnant women's perspectives on influenza vaccination during pregnancy and postpartum pertussis vaccination. Many women saw pregnancy as a busy time filled with advice on what they "should" and "should not" do to ensure the health of their fetus, and vaccinating themselves was regarded as just one of these tasks needing consideration. Women were more concerned about potential risks to their infants' health before their own. They saw influenza as a disease affecting the mother, whereas they viewed pertussis as a threat to the baby and therefore comparatively more risky. They were thus more likely to intend to vaccinate against pertussis to protect their infant. Framing of vaccination information toward protection of the baby might help increase vaccine uptake among pregnant women.

Swipe Left on Sexual Harassment: Understanding and Addressing Technology-Facilitated Sexual Violence on Dating Apps.

Dating violence is a pervasive issue that has become increasingly complex to address as technologies mediating interpersonal connections become more widely utilized. The incidence and ways in which violence manifests through digital media are not fully understood. This study aimed to better understand the relationship between geolocational dating apps like Tinder, Bumble, and Grindr and technology-facilitated sexual violence (TFSV) among university students. An anonymous survey was electronically administered to a convenience sample of 1,000 undergraduates at a large private university in the southeastern United States. Participants indicated their dating app usage and the frequency of specific TFSV experiences they had encountered. Chi-square tests were conducted to identify relationships between demographic characteristics and experiences of TFSV. Multivariate logistic regression was conducted to predict TFSV based on respondent characteristics. A total of 910 respondents completed the survey, with more than half (54%) of respondents reporting some type of TFSV while using dating apps. Women and non-heterosexual students experience significantly more TFSV than male and heterosexual students. While participants' academic year (first-year through senior) and participation in extracurricular activities were not associated with TFSV, dating app selection was a significant predictor of the likelihood to report TFSV, with Grindr users being significantly more likely to report. Major Implications Due to the near-ubiquitous use of dating apps in this population, interventions to address campus social norms, comprehensive sexuality education, and consent education, and improved regulation of TFSV by technology companies should be implemented- especially for cisgender, heterosexual women, and gender and sexual minorities.

Uptake of influenza vaccine by pregnant women: a cross-sectional survey.

OBJECTIVES: To determine influenza vaccination coverage among pregnant women in New South Wales, and factors associated with vaccine uptake during pregnancy. DESIGN, SETTING AND PARTICIPANTS: Quantitative self-administered survey of pregnant women, using a non-random, stratified sample from antenatal clinics at three demographically diverse hospitals in NSW during the influenza season of 2011. MAIN OUTCOME MEASURES: Self-reported influenza vaccine uptake while pregnant; and attitudes, barriers and facilitators to vaccine acceptance during pregnancy. RESULTS: Of 939 women approached, 815 participated (87%). Influenza vaccine uptake in pregnant women was 27%. Women who had received a recommendation to have the vaccine were 20.0 times (95% CI, 10.9-36.9) more likely to have been vaccinated. Forty-two per cent recalled receiving a recommendation to be vaccinated. Other factors associated with vaccination were study site, perceived infection severity, overall feelings toward vaccination during pregnancy, vaccine accessibility, and willingness to take up the vaccine if recommended. Concern about the baby's safety was negatively associated with vaccination (odds ratio, 0.5; 95% CI, 0.2-0.9), but 68% (95% CI, 63%-71%) of women who expressed concern agreed they would have the vaccine if their health care professional recommended it. CONCLUSION: Recommendation from a health care provider is strongly associated with influenza vaccine uptake among pregnant women and can overcome their concerns about safety, but less than half the women surveyed reported receiving such a recommendation. Educational material targeting pregnant women and professional education and support for antenatal health care providers are needed to increase awareness and recommendation.

Exploring human papillomavirus vaccination decision making through mother and adolescent dyad interviews.

INTRODUCTION: The purpose of our research was to explore how parents and their adolescent children make decisions about the human papillomavirus (HPV) vaccine, and to inform future interventions that aim to facilitate inclusive decision-making processes. METHOD: Purposive and snowball sampling strategies targeted parents and their adolescent children (ages = 11-13) in a large city in Australia. We conducted separate and joint semistructured interviews in 2013 with six mother-adolescent dyads (50% female adolescents and 50% male). Interviews were analyzed using a grounded theory approach. RESULTS: Factors that both facilitate and impede decision making emerged, including: background knowledge, values, historical experiences, parenting style, and opinion weights. DISCUSSION: New interventions, strategies, and tools that are informed by these decision-making factors can be used to aid productive, mutual decision making between parents and adolescents and support adolescent autonomy and self-sufficiency in health decision making. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Knowledge, Attitudes, and Practices towards PrEP from Cisgender Men and Transgender Women Who Have Sex with Men in the Largest Suburban HIV Epidemic.

We conducted a cross-sectional web-based study to assess attitudes and experiences with HIV pre-exposure prophylaxis (PrEP) amongst a multiracial cohort of gay, bisexual, and other men who have sex with men (MSM) and transgender women in Long Island, New York. Participants were recruited through clinical providers and community-based organizations. The survey assessed knowledge and attitudes toward PrEP and factors that facilitate willingness to take it. Of the 189 respondents, most participants were Latinx/Hispanic (57.1%; n = 105), gay-identifying (81.2%; n = 151), and cisgender men (88.7%; n = 165). One in five participants completed high school or lower (19.4%; n = 36). Among those who had never used PrEP (53.4%; n = 101), nearly all participants were willing to use it if it were free or covered as part of their insurance (89.4%; n = 84). The most common barriers to not using PrEP was not knowing where to obtain it (68.3%; n = 69), concerns about side effects (42.1%; n = 35), and concerns about affordability (38.5%; n = 25). This study discusses specific nuances to the suburbs, including cultural norms and structural barriers that should be incorporated in health promotion initiatives in addressing these factors.

Hookah use patterns, social influence and associated other substance use among a sample of New York City public university students.

BACKGROUND: Most hookah use studies have not included racial and ethnic minorities which limits our understanding of its use among these growing populations. This study aimed to investigate the individual characteristics of hookah use patterns and associated risk behaviors among an ethnically diverse sample of college students. METHODS: A cross-sectional survey of 2460 students (aged 18-25) was conducted in 2015, and data was analyzed in 2017. Descriptive statistics were used to present the sociodemographic characteristics, hookah use-related behavior, and binge drinking and marijuana use according to the current hookah use group, including never, exclusive, dual/poly hookah use. Multivariate logistic regression was conducted to examine how hookah related behavior and other risk behaviors varied by sociodemographics and hookah use patterns. RESULTS: Among current hookah users (n = 312), 70% were exclusive hookah users and 30% were dual/poly hookah users. There were no statistically significant differences in sociodemographic characteristics except for race/ethnicity (p < 0.05). Almost half (44%) of the exclusive hookah users reported having at least five friends who also used hookah, compared to 30% in the dual/poly use group. Exclusive users were less likely to report past year binge drinking (17%) and past year marijuana use (25%) compared to those in the dual/poly use group (44 and 48% respectively); p < 0.001. CONCLUSIONS: The socialization aspects of hookah smoking seem to be associated with its use patterns. Our study calls for multicomponent interventions designed to target poly tobacco use as well as other substance use that appears to be relatively common among hookah users.

Prospective mixed methods study of online and offline social networks and the development of sexual agency in adolescence: the Social Networks and Agency Project (SNAP) protocol.

INTRODUCTION: Social media may play a role in adolescent sexual development. The limited research on social media use and sexual development has found both positive and negative influences. The focus of this study is on sexual agency: a positive sexual outcome. This paper describes the protocol for the Social Networks and Agency Project (SNAP) study which aims to examine the relationship between online and offline social networks and the development of healthy relationships and sexual agency in adolescence. METHODS AND ANALYSIS: The SNAP study is a mixed methods interdisciplinary longitudinal study. Over an 18-month period, adolescents aged 15-17 years at recruitment complete three questionnaires (including demographics, sexual behaviour, sexual agency and social networks); three in-depth interviews; and fortnightly online diaries describing their sexual behaviour and snapshots of their social networks that week. Longitudinal analyses will be used to describe changes in sexual behaviour and experiences over time, sexual agency, social media use, and social network patterns. Social network analysis will be used to capture relational data from which we will be able to construct sociograms from the respondent's perspective. Interview data will be analysed both in relation to emergent themes (deploying a grounded theory approach), and from a cross-disciplinary perspective. This mixed method analysis will allow for comparisons across quantitative and qualitative data, for consistency and differences, and will enhance the robustness of data interpretation and conclusions drawn, as multiple data sources are triangulated. ETHICS AND DISSEMINATION: Ethical approval was granted by the University of Sydney Human Research Ethics Committee and the Family Planning New South Wales Ethics Committee. The study will provide comprehensive, prospective information on the social and sexual development of adolescents in the age of social media and findings will be disseminated through conference presentations and peer-reviewed publications.

Drive for thinness and attention toward specific body parts in a nonclinical sample.

OBJECTIVE: To examine the differences between participants scoring high versus low on a drive for thinness construct concerning their visual attention toward specific body parts. We hypothesized that participants scoring high on the drive for thinness subscale would show increased attention to body regions, which are important in the assessment of body weight and thinness like the waist, hips, legs, and arms. METHOD: We examined eye-gaze behavior of a nonclinical sample of 51 male and female college students with an eye-tracking system as they were looking at pictures of young, attractive males and females. In addition, we used the Eating Disorder Inventory to measure drive for thinness. RESULTS: Participants with increased scores on the drive for thinness subscale looked longer and more often to the waist, hips, legs, and arms as compared with low scorers. In addition, they showed decreased attention toward the head or face. CONCLUSION: The results indicate that participants scoring high on drive for thinness show an attentional bias toward body regions that are associated with assessing changes in weight. However, they neglected the face, which is the most important source of social and affective information when looking at others.

Is sexual content in new media linked to sexual risk behaviour in young people? A systematic review and meta-analysis.

BACKGROUND: Social networking and digital media increasingly have an impact on the lives of young people. We undertook a systematic review and meta-analysis of studies that examined the relationship between exposure to sexually explicit websites (SEWs) and 'sexting' (i.e. sending semi-nude or nude photos from a mobile phone) and the sexual attitudes and practices of young people. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement, Medline, EMBASE and PsycINFO were searched for papers that described the statistical association between viewing SEWs or sexting by young people (defined as 10-24 years) and their sexual attitudes and behaviours. RESULTS: Fourteen studies, all cross-sectional in design, met the inclusion criteria. Six studies (10352 participants) examined young people's exposure to SEWs and eight (10429 participants) examined sexting. There was substantial variation across studies in exposure and outcome definitions. Meta-analyses found that SEW exposure was correlated with condomless sexual intercourse (odds ratio (OR) 1.23, 95% confidence interval (CI): 1.08-1.38, two studies); sexting was correlated with ever having had sexual intercourse (OR 5.58, 95% CI: 4.46-6.71, five studies), recent sexual activity (OR 4.79, 95% CI: 3.55-6.04, two studies), alcohol and other drug use before sexual intercourse (OR 2.65, 95% CI: 1.99-3.32, two studies) and multiple recent sexual partners (OR 2.79, 95% CI: 1.95-3.63, two studies). Most studies had limited adjustment for important potential confounders. CONCLUSIONS: Cross-sectional studies show a strong association between self-reported exposure to sexual content in new media and sexual behaviours in young people. Longitudinal studies would provide a greater opportunity to adjust for confounding, and better insight into the causal pathways underlying the observed associations.

What predicts postpartum pertussis booster vaccination? A controlled intervention trial.

BACKGROUND: 'Cocooning' aims to protect susceptible infants from pertussis via caregiver vaccination. Control trials evaluating educational interventions to promote cocooning are lacking. We evaluated the role of message-framing vs. standard health information in promoting pertussis vaccination. METHODS: We recruited postpartum women from a maternity hospital in Sydney, Australia (November 2010-July 2012). Participants self-completed a pertussis knowledge and attitudes questionnaire. We then assigned pertussis-susceptible (no pertussis vaccine ≤10 years) participants to receive a gain-framed, loss-framed pamphlet or control (Government Pertussis factsheet) using weekly sequential block allocation. Next, participants were offered a pertussis vaccine (dTpa) and completed a post-questionnaire on discharge. RESULTS: A baseline questionnaire was completed for 96.4% (1433/1486) of postpartum women approached. Missing data was excluded (n=29). Next, participants (1404) were screened for vaccine status: 324 (23%) reported prior pertussis booster vaccine receipt, leaving 1080 participants requiring vaccination. Among susceptible mothers, 70% (754/1080) were vaccinated post-intervention. Rates were similar between 'gain', 'loss' or 'control' pamphlets (69.1% vs. 71.8% vs. 68.8%; p=0.62). Intention to be vaccinated (OR 2.46, p<0.001; 95% CI: 1.69-3.58), perceived vaccine benefits (OR: 1.61, p<0.001; 95% CI: 1.25-2.15) and having received a vaccine recommendation (OR 1.68; p=0.025; 95% CI: 1.07-2.65) were independent predictors of vaccine uptake. At discharge, overall pertussis vaccine coverage had increased from 23% to 77% among women screened (1078/1404). CONCLUSION: A cocooning strategy for pertussis vaccination can be highly effective when partially implemented within maternity hospitals, with information accompanied by a funded vaccine. Mothers were highly receptive to vaccination in the postnatal ward: facts about pertussis were as effective as message-framing in promoting a high uptake of 70%. Perceived vaccine benefits, intentions and vaccine recommendation were important predictors of uptake. Our intervention trial increased the existing pertussis vaccine coverage of 23-77%.

Educational interventions to increase HPV vaccination acceptance: a systematic review.

BACKGROUND: The Human papillomavirus (HPV) vaccine has been available for protection against HPV-associated cervical cancer and genital warts since 2006. Nonetheless, uptake has varied among countries and populations within countries. Studies have found that individuals' knowledge and attitudes toward the vaccine are associated with immunization uptake. The purpose of the current review is to summarize and evaluate the evidence for educational interventions to increase HPV vaccination acceptance. METHODS: We searched the databases of PubMed and Web of Science for English-language articles describing educational interventions designed to improve HPV vaccination uptake, intention or attitude. RESULTS: We identified 33 studies of HPV vaccination educational interventions: 7 tested the effectiveness of interventions with parents, 8 with adolescents or young adults, and 18 compared the effectiveness of different message frames in an educational intervention among adolescents, young adults or their parents. Most studies involved populations with higher educational attainment and most interventions required participants to be literate. The minority of studies used the outcome of HPV vaccine uptake. Well-designed studies adequately powered to detect change in vaccine uptake were rare and generally did not demonstrate effectiveness of the tested intervention. CONCLUSIONS: There is not strong evidence to recommend any specific educational intervention for wide-spread implementation. Future studies are required to determine the effectiveness of culturally-competent interventions reaching diverse populations.

"Nobody told me nothin": communication about menstruation among low-income African-American women.

The purpose of this study was to explore communication about menstruation among low-income African American women and the impact of this communication on their understanding of and attitudes toward the menstrual events that will occur throughout their lives. This is of particular importance since minority women disproportionately face greater menstrual problems than those experienced by majority women in the United States. A grounded theory design was used for this study. Seventeen African American women from a public housing project were interviewed. The core theme that emerged from the qualitative data was the avoidance or negative discussion of menstrual events throughout the women's lives. The women had few sources of and very limited menstrual learning from school, their mothers, and other women. This led to confusion and inaccurate beliefs about and negative attitudes toward menstruation, menopause, and menstrual-related health conditions. While these women desired to have better communication, their history of avoidance of and negative discussions surrounding menstruation will likely continue to make it difficult for them to have positive and informative discussions with others in the future unless some type of educational intervention occurs.