E-Mentoring to Address Youth Health: A Systematic Review.

Electronic mentoring (e-mentoring), the integration of digital technology in mentoring relationships, has recently grown in popularity; however, the effectiveness of e-mentoring in addressing youth health has not been synthesized to date. The current study synthesizes the literature on e-mentoring to affect the health and well-being of youth (10-24 years) through a systematic review and evidence quality assessment. A total of 833 records were identified, of which 14 met eligibility criteria (published in English since 1995, targeted youth health and/or youth with health issues, and communication was entirely digital or combined with in-person interaction). The results showed that the majority of health-focused e-mentoring studies were conducted with young people with existing health conditions rather than on the use of e-mentoring to promote overall health and wellness. The included programs focused largely on bringing mentoring to youth subpopulations that may be challenged by in-person models. Quality assessments of the included studies showed that the strength of the evidence is mediocre. The findings suggest that e-mentoring has the potential to reach youth with unique health concerns and to promote independent management of health conditions as youth transition to adulthood; however, more rigorous evaluation of e-mentoring programs with larger sample sizes is needed. Supplementary Information: The online version contains supplementary material available at 10.1007/s40894-021-00172-3.

Mentoring Young African American Men and Transgender Women Who Have Sex With Men on Sexual Health: Formative Research for an HIV Mobile Health Intervention for Mentors.

BACKGROUND: African American men who have sex with men (MSM) and transgender women bear a disproportionate burden of HIV. Young MSM account for 75% of this burden for youth. When youths lack socially protective resources such as strong networks of adults, including parents, teachers, or community members, mentors may play a critical role in promoting health behaviors. This is especially true for youth at risk for HIV, such as African American youth with sexual and gender minority (SGM) identities. In the past decade, natural mentoring and mentoring programs have proliferated as a key prevention and intervention strategy to improve outcomes for young people at risk for poor academic, social, and health issues. Mentors appear to be able to facilitate health promotion among young SGM by modeling healthy behaviors; however, mentors' knowledge and resource needs regarding sexual health topics including HIV are understudied, as is the potential role of mobile technology in enhancing mentoring relationships and the ability of mentors to learn about sensitive issues faced by youth. OBJECTIVE: The aim of this study is to explore how mentoring plays a role in the sexual health of African American SGM youth and understand how mentoring relationships can be strengthened through mobile technology to promote youth HIV prevention behaviors. METHODS: In-depth interviews were conducted with African American SGM youth mentees (n=17) and mentors (n=20) to such youths in 3 Mid-Atlantic cities. Mentee interviews focused on discussions regarding sexual health and HIV and how a mentor could broach such topics. Mentor interviews explored whether sexual health and HIV are currently mentoring topics, mentors' knowledge and confidence in mentoring on these issues, and barriers to discussions. All participants were asked if a mobile app could help facilitate mentoring on sensitive health issues, particularly HIV and sexual health. Data were transcribed, coded, and analyzed for relevant themes. RESULTS: Sexual health was a common topic in mentoring relationships, occurring more in natural mentorships than in mentoring program pairs. Mentors and mentees felt positive about such discussions. Mentors expressed having limited knowledge beyond condom use and HIV testing, and expressed a need for more complete resources. Both mentors and mentees had mixed comfort levels when discussing sexual health. Sufficient trust and shared lived experiences made discussions easier. Mentees have multifaceted needs; however, mentors stated that an app resource that provided self-training, resources, support from other mentors, and tips for better mentoring could prove beneficial. CONCLUSIONS: For the African American SGM community, access to natural mentors is crucial for young people to learn healthy behaviors. A mobile resource to assist mentors in confidently having discussions with mentees may be a promising way to promote healthy practices.

Interventions using new digital media to improve adolescent sexual health: a systematic review.

New digital media (e.g., the Internet, text messaging, and social networking sites [SNS]) have dramatically altered the communication landscape, especially for youth. These communication platforms present new tools for engaging youth in sexual health promotion and risk reduction. We searched eight public databases across multiple disciplines for all peer-reviewed studies published between January 2000 and May 2011 that empirically evaluated the impact of digital media-based interventions on the sexual health knowledge, attitudes, and/or behaviors of adolescents aged 13-24 years. Of 942 abstracts, 10 met inclusion criteria. Seven studies were conducted in the United States. Eight described Web-based interventions, one used mobile phones, and one was conducted on an SNS. Two studies significantly delayed initiation of sex, and one was successful in encouraging users of an SNS to remove sex references from their public profile. Seven interventions significantly influenced psychosocial outcomes such as condom self-efficacy and abstinence attitudes, but at times the results were in directions unexpected by the study authors. Six studies increased knowledge of HIV, sexually transmitted infections, or pregnancy. This area of research is emerging and rapidly changing. More data from controlled studies with longer (>1 year) follow-up and measurement of behavioral outcomes will provide a more robust evidence base from which to judge the effectiveness of new digital media in changing adolescent sexual behavior.

The intersection of youth, technology, and new media with sexual health: moving the research agenda forward.

Youth bear a significant proportion of the sexually transmitted infection (STI)/HIV burden in the United States, CDC, 2010. Available at: http://www.cdc.gov/std/stats09/default.htm, with rates of some STIs increasing among youth of color and young men who have sex with men. Technology use among youth also continues to increase. The ubiquitous nature of technology use among youth offers a multitude of opportunities to promote youth sexual health and to prevent disease transmission and unplanned pregnancies. To date, there have been a handful of peer-reviewed articles published regarding the feasibility, acceptability, and effectiveness of using new media and technology for sexual health promotion. Despite recent publications, there is still a real need for high-quality research to understand the impact of different forms of new media use on youth sexual health, as well as to determine the best ways to harness technology to promote safer sex behaviors, both for the short- and long-term. In March 2011, Internet Sexuality Information Services (ISIS), National Institute of Mental Health (NIMH), and the Ford Foundation convened a meeting of scientists and technology experts to discuss how to effectively conduct sexual health promotion research using new forms of technology. The meeting was structured to cover the following topic areas: (i) research-community partnerships, (ii) institutional review board and ethical issues, (iii) theoretical frameworks, (iv) intervention approaches, (v) recruitment methods, and (vi) assessing impact. Presentations included case studies of successful technology-based HIV/STI prevention interventions for youth, which led to broader discussions on how to conduct research in this area. This article summarizes the meeting proceedings, highlights key points, offers recommendations, and outlines future directions.

Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use.

Seroadaptive behaviors have been widely described as preventive strategies among men who have sex with men (MSM) and other populations worldwide. However, causal links between intentions to adopt seroadaptive behaviors and subsequent behavior have not been established. We conducted a longitudinal study of 732 MSM in San Francisco to assess consistency and adherence to multiple seroadaptive behaviors, abstinence and condom use, whether prior intentions predict future seroadaptive behaviors and the likelihood that observed behavioral patterns are the result of chance. Pure serosorting (i.e., having only HIV-negative partners) among HIV-negative MSM and seropositioning (i.e., assuming the receptive position during unprotected anal sex) among HIV-positive MSM were more common, more successfully adhered to and more strongly associated with prior intentions than consistent condom use. Seroconcordant partnerships occurred significantly more often than expected by chance, reducing the prevalence of serodiscordant partnerships. Having no sex was intended by the fewest MSM, yet half of HIV-positive MSM who abstained from sex at baseline also did so at 12 month follow-up. Nonetheless, no preventive strategy was consistently used by more than one-third of MSM overall and none was adhered to by more than half from baseline to follow-up. The effectiveness of seroadaptive strategies should be improved and used as efficacy endpoints in trials of behavioral prevention interventions.

HIV seroadaptation among individuals, within sexual dyads, and by sexual episodes, men who have sex with men, San Francisco, 2008.

"Seroadaptation" comprises sexual behaviors to reduce the risk of HIV acquisition and transmission based on knowing one's own and one's sexual partners' serostatus. We measured the prevalence of seroadaptive behaviors among men who have sex with men (MSM) recruited through time-location sampling (TLS) across three perspectives: by individuals (N = 1207 MSM), among sexual dyads (N = 3746 partnerships), and for sexual episodes (N = 63,789 episodes) in the preceding six months. Seroadaptation was more common than 100% condom use when considering the consistent behavioral pattern of individuals (adopted by 39.1% vs. 25.0% of men, respectively). Among sexual dyads 100% condom use was more common than seroadaptation (33.1% vs. 26.4%, respectively). Considering episodes of sex, not having anal intercourse (65.0%) and condom use (16.0%) were the most common risk reduction behaviors. Sex of highest acquisition and transmission risks (unprotected anal intercourse with a HIV serodiscordant or unknown status partner in the riskier position) occurred in only 1.6% of sexual episodes. In aggregate, MSM achieve a high level of sexual harm reduction through multiple strategies. Detailed measures of seroadaptive behaviors are needed to effectively target HIV risk and gauge the potential of serosorting and related sexual harm reduction strategies on the HIV epidemic.

Comparing internet-based and venue-based methods to sample MSM in the San Francisco Bay Area.

Methods of collecting behavioral surveillance data, including Web-based methods, have recently been explored in the United States. Questions have arisen as to what extent Internet recruitment methods yield samples of MSM comparable to those obtained using venue-based recruitment methods. We compare three recruitment methods among MSM with respect to demographic and risk behaviors, one sample was obtained using time location sampling at venues in San Francisco, one using a venue based like approach on the Internet and one using direct-marketing advertisements to recruit participants. The physical venue approach was most successful in completing interviews with approached men than both Internet approaches. Respondents recruited via the three methods reported slight differences in risk behavior. Direct marketing internet recruitment can obtain large samples of MSM in a short time.

Online syphilis testing--confidential and convenient.

OBJECTIVE: In response to the current syphilis epidemic among men who have sex with men, the San Francisco Department of Public Health sought to increase syphilis testing by offering testing in nonclinical settings. GOAL: The goal of this study was to collaborate with a community-based organization, Internet Sexuality Information Services, Inc. (ISIS), to design an innovative, confidential, online testing service for syphilis. STUDY: The service, called STDTest.org, was launched in June 2003. The web site allows people to print out a laboratory requisition slip, have their blood drawn, and receive their test results online. RESULTS: During the first year, 218 tests were performed and 13 persons had reactive serologies. Six patients were diagnosed with a new syphilis infection and treated. CONCLUSIONS: Online syphilis testing offers a free and convenient alternative to getting tested at the San Francisco municipal sexually transmitted disease clinic and an additional means for detecting syphilis cases.