Knowledge, sex, and region associated with primary care providers prescribing adolescents HIV pre-exposure prophylaxis.

Although HIV pre-exposure prophylaxis (PrEP) effectively and safely prevents HIV among adolescents, uptake of PrEP is low. Adolescents must have primary care providers (PCPs) prescribe them PrEP, making PCPs critical actors in PrEP delivery. However, research has primarily investigated determinants of PCPs' intention to prescribe adolescents PrEP rather than the determinants of performing the behavior itself. We examined the demographic, clinical practice, and implementation determinants of PCPs previously prescribing PrEP to adolescents. PCPs were recruited from a national Qualtrics panel of licensed medical providers in the United States from July 15-August 19, 2022. The Theoretical Domains Framework informed the implementation determinants measured. A multivariable logistic regression was used. PCPs who were more knowledgeable of the CDC guidelines (aOR 2.97, 95% CI 2.16-4.10), who were assigned male at birth (aOR 1.64, 95% CI 1.03-2.59), and who practiced in the Western region (aOR 1.85, 95% CI 1.04-3.30) had greater odds of prior prescribing adolescents PrEP. Provider-based educational interventions should be designed, implemented, and tested to encourage PCPs to prescribe PrEP to eligible adolescents.

Implementation Factors Associated With Primary Care Providers' Intention to Prescribe HIV PrEP to Adolescents in the United States.

PURPOSE: In the United States, adolescents (those 13-18 years old) are a key age group of those at risk for and affected by HIV. Although HIV pre-exposure prophylaxis (PrEP), one promising HIV prevention tool, is approved for eligible adolescents to use, adolescent access to PrEP is limited by primary care providers' (PCPs) willingness to prescribe it. This study examined which Theoretical Domains Framework factors are associated with PCPs' intention to prescribe PrEP to sexually active adolescents. METHODS: A total of 770 licensed PCPs practicing family medicine, internal medicine, or pediatrics in the United States completed an online cross-sectional questionnaire. Participants were recruited through a Qualtrics panel. We used a hierarchical regression to assess the association of demographic characteristics, sexual health care practices, and the 10 Theoretical Domains Framework factors with intention to prescribe PrEP to sexually active adolescents aged 13-18 years old. RESULTS: Although nearly all PCPs had heard about PrEP (90.9%), 30.6% ever prescribed PrEP to an adolescent. Intention to prescribe PrEP to sexually active adolescents was associated with seven out of the 10 Theoretical Domains Framework factors: knowledge, skills, professional role, belief capacity, belief consequence, environmental resource, social influence, and emotion. DISCUSSION: Our findings demonstrate that the Theoretical Domains Framework can be employed to understand the intrapersonal, interpersonal, and environmental factors associated with PCPs' intention to prescribe sexually active adolescents PrEP. Implementation strategies are needed to implement interventions that improve provider knowledge, attitudes, and skills related to prescribing PrEP to eligible adolescents.

Linking Sexting Expectancies with Motivations to Sext.

While many researchers have explored the impact sexting may have on relationships and mental health, few have explored the motivations and expectancies as to why individuals engage in sexting. By understanding why individuals sext their partners, we can learn more about what drives the behavior. Therefore, the current study sought to determine if sexting for sexual purposes (SP) or body image reinforcement (BIR) would predict positive sext expectancies. There was no prediction for instrumental/aggravated reasons (IAR). The online questionnaire had 348 participants, and based on regression analysis, positive sext expectancies while sending a sext message predicted sexting for sexual purposes. Somewhat surprisingly, sexting for instrumental/aggravated reasons was predicted by negative sext expectancies (both sending and receiving). These findings demonstrate individuals who sext for sexual purposes, and have positive sext expectancies, appear to enjoy the consequences of that behavior. Individuals who sext for instrumental/aggravated reasons may be uncomfortable with the outcome of their sexting behavior. This result highlights an area where clinicians could help clients explore the true reinforcements behind IAR.

The impact of initial social distancing measures on individuals' anxiety and loneliness depending on living with their romantic/sexual partners.

In response to the COVID-19 pandemic, large swaths of the U.S. were under stay-at-home orders, thus preventing many individuals from leaving their homes. While previous studies have shown that such orders can be detrimental to mental health, specific mental health outcomes, such as loneliness and anxiety, have yet to be fully explored, particularly among various living situation contexts (e.g., living alone, with romantic/sexual partners, without romantic/sexual partners). The current study explores this using a mixed-methods approach. Data were collected via Amazon's M-Turk (N = 85). Kruskal-Wallis tests revealed significant differences between the three groups with respect to loneliness. Statistically significant greater levels of loneliness were found in individuals living alone compared to those living with romantic/sexual partners and those living with non-romantic/sexual partners. No significant differences in anxiety levels were detected. Qualitative analysis revealed similar themes among all groups regarding anxiety. When asked about loneliness, however, those living alone shared more about feeling isolated, unwanted feelings of solitude, and how technology only mitigates a portion of these feelings. Those living with others and sexual partners shared desires to see friends and co-workers, yet not to the severity described by individuals living alone. Romantic/sex life themes are also discussed.

Applicant factors contributing to interview selection, ranking determination, and judgement of "Fit" among health service psychology internship training programs.

BACKGROUND: The predoctoral internshipAQ4 training year is the capstone training experience for health service doctoral students. Previous research has explored what applicant characteristics are desired by internship sites and has not thoroughly explored differences between types of sites or criteria importance at different stages of applicant consideration (interview vs. ranking). AIMS: We evaluate current perceptions of doctoral student internship applications by training directors. MATERIALS AND METHODS: Internship training directors of APA-accredited sites report on the importance of different application materials during interview and ranking decisions. We also compare these rankings across site types. RESULTS: Results indicate that internship sites were generally consistent in their criteria rankings; however, there were also some differences. Intern applicant "fit" continues to be the most important criteria by which applicants are judged at all stages of consideration. Qualitative analysis found that "fit" varied by site across themes of treatment, applicant, and site characteristics. DISCUSSION: We discuss implications in their preparation of internship applications. In addition to the practical guidance for students, we discuss how program changes can increase applicant site competitiveness.

Preferred Methods of HIV and Sexually Transmissible Infection Screening Delivery Among a Rural Sample of Men Who Have Sex with Men.

Despite the national HIV and sexually transmissible infection (STI) rates growing in rural areas, rural populations-particularly men who have sex with men (MSM), have limited access to secondary (i.e., HIV/STI screening) prevention activities compared with their urban counterparts. We conducted semistructured in-depth interviews with 23 rural MSM residing in Oklahoma and Arkansas to assess their (1) experiences with HIV and STI testing; (2) perceptions of at-home testing; and (3) preferences for receiving results and care. Barriers to accessing HIV/STI screening included lack of medical providers within rural communities, privacy and confidentiality concerns, and perceived stigma from providers and community members. To overcome these barriers, all participants recognized the importance of screening paradigms that facilitated at-home screening, medical consultation, and care. This included the ability to request a testing kit and receive results online, to access affirming and competent providers utilizing telemedicine technology, as well as prompt linkage to treatment. These narratives highlight the need for systems of care that facilitate HIV and STI screening within rural communities, which do not require participants to access services at traditional physical venues.

Identifying Distinct Subgroups of Lesbian, Gay, and Bisexual Youth for Suicide Risk: A Latent Profile Analysis.

PURPOSE: The purpose of the study was to identify profiles of lesbian, gay, and bisexual (LGB) youth who are at risk for suicidal behavior. METHOD: Data were collected through the Youth Risk Behavior Surveillance System (N = 2,738). We used latent profile analysis to create identity profiles using variables associated with suicide, including bullying, alcohol use, poor grades, electronics use, and sleep hours. RESULTS: The LPA revealed a 6-class solution. Class 6 represented the highest risk profile with the highest scores in alcohol, bullying, poor grades, electronics use, and the least sleep and were 17 times more likely to attempt suicide compared to class 2 (the lowest-risk class). Classes 1, 3, 4, and 5 had a mixture of both high and low risk mean scores across the variables, with class 3 showing the strongest relationship to suicide (7 times more likely than class 2). CONCLUSION: Because high-risk classes in our study had multiple factors contributing to associations to suicide, programming aimed at attenuating youth suicide among LGB youth may benefit from addressing multiple issues simultaneously (e.g., substance use and bullying). This would be a departure from more traditional programs for LGB youth which are predicated on one specific risk behavior, such as coping with bullying or substance use separately.

Interface of Internalized Homophobia and Community Connectedness on Frequency of Doctor's Visits for Rural and Urban MSM in Oklahoma.

PURPOSE: Men who have sex with men (MSM) face persistent risk of stigma, with past studies showing unequal treatments of MSM in health care settings. Contextual factors, such as internalized homophobia and connectedness to one's community, have shown to serve as a barrier or facilitator (respectively) with regard to MSM's decisions to seek preventative treatment. These studies, however, predominately feature urban populations, with less consideration given to rural MSM. The current study comparatively investigates these contextual factors between rural and urban MSM to detect differences in the frequency of doctor's visits. METHODS: A 2-by-2 (rural/urban × doctor visit yes/no) multivariate analysis of variance (MANOVA) was conducted to investigate if significant differences and/or interactions existed for internalized homophobia and community connectedness. FINDINGS: Results show a significant interaction between rurality and doctor's visits in our sample of predominantly white, self-identified gay men. Higher levels of internalized homophobia and lower levels of community connectedness were seen in rural individuals who had visited a doctor in the past 12 months and in urban individuals who had not seen a doctor in the past 12 months. CONCLUSIONS: Study findings have implications for future public health research and for health promotion interventions, practices, and policies for MSM in rural areas. Social exclusion reinforces the invisibility of lesbian, gay, bisexual, and transgender (LGBT) populations, particularly in rural areas. Stigma and marginalization of MSM promote structural barriers inhibiting care. Our results give evidentiary support for programs which inform the work of clinicians on mechanisms to create LGBT-inclusive practice settings.

Assessing the Health Care Experiences of Rural Men Who Have Sex with Men (MSM).

Research investigating the health care experiences of men who have sex with men (MSM) predominately concerns urban populations. This study examines the health care experiences of MSM residing in rural Oklahoma. A total of 40 MSM (aged 21 through 66) living in rural areas were interviewed. Data were analyzed using a qualitative approach to identify emerging concepts. Three themes emerged from the data: First, participants cited cultural differences related to religious conservative ideologies as a central motif of health care experiences. Next, doctor-patient relationship quality was a contributing factor to health care experiences. Last, health care experiences were predicated on the idea of doctors' knowledge of lesbian, gay, bisexual and transgender (LGBT) health issues. Certain health care aspects regarding the rural experiences of MSM that were identified differed between rural and urban MSM. Implications include support for programs that bridge the gap between practitioners and patients, while better informing both MSM and health care providers of current LGBT health issues.

Factors Associated with Condom Use among a Sample of Men Who Have Sex with Men (MSM) Residing in Rural Oklahoma.

Public health literature often neglects populations from rural communities, particularly with men who have sex with men (MSM). Although HIV/STI infections are decreasing slightly, there is an increase within rural MSM, thus opening the door for further research on condom use behavior in a rural context. In-depth interviews were conducted with 40 MSM in rural Oklahoma regarding their condom use and sexual behaviors. A qualitative analysis revealed five themes with respect to condom usage: physical discomfort of condoms, relationship trust, usage based on the type of sexual act, substance use, and knowledge of a partner's HIV/STI status. A sixth theme within the context of rural Oklahoma revealed participants' fear of physical/verbal abuse, hesitations seeking medical help due to confidentially issues, and general acknowledgment of the lack of education and resources available. Implications include increasing mobile testing locations and a push for marketing greater confidentially within health service providers.

Sex-Ed without the Stigma: What Gay and Bisexual Men Would like Offered in School Based Sex Education.

This study highlights the experiences of gay and bisexual men who live in Oklahoma with formalized sex education. Open-ended prompts were provided to individuals (N= 112) who completed an online questionnaire assessing their experience with sex education and what they would like to see offered. The majority of participants did not receive a formalized sex education and they want to see a comprehensive sex education program provided in public schools. A need exists for a more comprehensive and inclusive formalized sex education program to be provided in socio-politically conservative areas like Oklahoma.

Experiences of Stigma by Gay and Bisexual Men in Rural Oklahoma.

Purpose: The unique experiences of men who have sex with men (MSM) residing in culturally conservative rural areas are not well represented in the scientific literature. The human immunodeficiency virus (HIV) epidemic in the United States has shifted toward rural areas where populations are dispersed and health care resources are limited. Methods: We recruited 40 sexual minority men, ages 22-66, residing in rural Oklahoma for in-depth, qualitative sexual health interviews that sought to understand how cultural and social environments impacted health behaviors. Findings: Participants described a stigmatizing social environment and less access to quality, sexual minority medical care within rural communities and perceived these as substantial barriers to enhancing health. Structural issues, including lack of sexual minority-affirming policies, institutional practices, and hostile cultural norms, were noted. Conclusions: Results indicate the need to develop greater awareness of stigma as an etiologic factor that contributes to the health of rural sexual minority populations, specifically when it relates to provision of culturally appropriate care.

"What Should Sex Look Like?" Students' Desires for Expanding University Sexual Assault Prevention Programs to Include Comprehensive Sex Education.

Rates of sexual assault and sexual violence among college-aged adults are much higher than the national rates of sexual assault and sexual violence. Therefore, reduction and prevention of sexual violence among university students is critical and is consistent with national public health priorities. Often times, messages to students focus only on sexual assault and omit larger notions of sexual health. Four focus groups with a total of 24 participants (nine men, 15 women) highlighted three main perceptions about the sexual assault programming offered at this large university: themes of resistance to traditional programming, a need for holistic sexual health programming, and a desire to have an environment, which normalizes conversations surrounding sex, sexuality, and sexual health.

Adverse childhood experiences and MSM marijuana use.

BACKGROUND: Past research identified individuals who experienced adverse childhood experiences (ACEs) are at a higher risk of drug use. There is evidence to suggest that identifying as a man who has sex with other men (MSM) may increase the likelihood of drug use when adverse childhood experiences are prevalent. However, research has not addressed if this association is present in both rural and urban MSM, as other studies found that rurality/urbanity is a key determinant in detrimental outcomes for MSM. The current study uses ACEs as an independent variable in comparing rural and urban MSM's self-reported marijuana use. METHODS: Participants included 156 MSM residing in Oklahoma. Linear regression was used to test ACEs' associations with reported marijuana use. To explore nuanced differences between rural and urban populations, split sample regressions were conducted. RESULTS: ACEs were statistically associated with reported marijuana use in the full sample. However, after splitting the sample, ACEs only predicted reported marijuana use in the urban and not in the rural sample. CONCLUSIONS: Results suggest ACEs may affect rural and urban MSM dissimilarly. It is unclear, however, if rural MSM engage in maladaptive behaviors other than marijuana use, or if factors associated with urban environments make urban MSM more vulnerable to illicit drug use when ACEs are high. Regardless, trauma informed programming targeting MSM should consider geographic locale as an influential factor. Further investigation is needed with regards to geographic locale, ACEs, and other illicit drug use in MSM populations.

Motivations for Nonuniversity-Based Adults Who Sext Their Relationship Partners.

Little is known about motivations of adults who sext their relationship partners. Participants (N = 126, 71 male) completed an online questionnaire to assess their motivations for sexting their current relationship partner(s). The results of a MANOVA indicated the overwhelming motivation was to initiate sexual behaviors for all groups. Other motivations of instrumental/aggressive reasons were significantly higher for heterosexual men, and body image reinforcement was significantly higher for sexual-minority men. With results indicating the main motivation to sext was to initiate sexual behaviors, the potential of using sexting as an intervention to increase sexual intimacy in relationships is discussed.

Barriers to Access and Adoption of Pre-Exposure Prophylaxis for the Prevention of HIV Among Men Who Have Sex With Men (MSM) in a Relatively Rural State.

Biomedical intervention approaches, including antiretroviral pre-exposure prophylaxis (PrEP), have been demonstrated to reduce HIV incidence among several at-risk populations and to be cost effective. However, there is limited understanding of PrEP access and uptake among men who have sex with men (MSM) residing in relatively rural states. Twenty semistructured interviews were conducted (August-November 2016) to assess opinions of and perceived barriers to accessing and adopting PrEP among MSM residing in Oklahoma. Participants perceived substantial barriers to accessing PrEP including a stigmatizing environment and less access to quality, LGBT-sensitive medical care. Overall, geographic isolation limits access to health providers and resources that support sexual health for Oklahoma MSM. Addressing stigma situated across ecological levels in an effort to increase adoption of PrEP by MSM residing in rural states remains necessary. Without this, social determinants may continue to negatively influence PrEP adoption and sexual health outcomes.

Sexting Behaviors Exhibited by Men Who Have Sex with Men Between the Ages of 18-70 Who Live in a Socially Conservative State.

Sexting, defined as the sending and receiving of sexually suggestive or sexually explicit text or photos, has been growing in prevalence. Recent studies have demonstrated that over half of individuals sampled over 17 and regardless of gender participate in some type of sexting behavior. Most studies on sexting behaviors, including those looking at men who have sex with men (MSM) focus on emerging adult or university-based populations. The goal of the current study was to sample a nonuniversity-based MSM adult population to determine the prevalence of sexting behavior and the odds that a person engages in sexting behaviors based on certain sexual behaviors. The sample consisted of 213 MSM (mean age = 34.8 years, standard deviation [STD] = 12.1) who reside in Oklahoma. The majority of participants (133, 62.4 percent) participated in sexting behaviors. Logistic regression indicated that individuals had 10 times higher odds to engage in sexting if they had participated in a hookup (odds ratio [OR] = 10.44, 95% CI = [4.16-26.25]) and individuals who are married or in a committed relationship had 71 percent lower odds that they had sent a sext message (OR = 0.29, 95% CI = [0.12-0.71]). Sexting behaviors were not associated with condom use. Implications, including using third-party geolocation mobile application (such as Grindr) to deliver sexual health information, are discussed.

Sexting Leads to "Risky" Sex? An Analysis of Sexting Behaviors in a Nonuniversity-Based, Older Adult Population.

Since few researchers have analyzed sexting behaviors in nonuniversity-based adult samples, we sought to determine if sexting is associated with negative psychological correlates and risky sexual behaviors in this population. Analysis of individuals who indicated having vaginal or anal sex in the past 12 months and who identified as single (n = 377) showed that condomless sex is independent of sexting behaviors. Results for those in committed relationships (n = 374) and having had vaginal or anal sex in the past 12 months also demonstrated condomless sex and sexting behaviors were not related. Furthermore, alcohol consumption and relational health were predictive of sexting behaviors in adults in committed relationships. These findings demonstrate that while risky sexual behavior and negative psychological correlates are associated with sexting and younger populations, the same might not be true for a nonuniversity-based, older adult sample.