<p>A cross- sectional descriptive study using a self-administered close-ended questionnaire was conducted with pupils in standards four to seven (aged 10 &ndash / 17 years) in ten government primary schools in Meru District. The sample of 400 school pupils was obtained by a simple random sampling technique. Data analysis was done using Statistical Package for Social Sciences SPSS (version 15) computer software and the results were presented in frequencies using simple percentages, tables and graphs. The Chi-square test was used to assess the significance where a p-value of &lt / 0.05 was considered statistically significant. In conclusion, Primary school pupils in Meru district engage in several risky sexual behaviors including substance use, sexual coercion, early sexual debut and engaging in various sexual practices. This calls for a more comprehensive approach in the fight against HIV among primary school children in Tanzania, which could include life skill training at an early age, behaviour change communication interventions, advocacy activities to influence policy formulation, condom promotion and incorporating key stakeholders in the rollout of school based HIV programmes such as parents, community leaders and faith-based organizations leaders.</p>

Magister Public Health - MPH / A cross- sectional descriptive study using a self-administered close-ended questionnaire was conducted with pupils in standards four to seven (aged 10 - 17 years) in ten government primary schools in Meru District. The sample of 400 school pupils was obtained by a simple random sampling technique. Data analysis was done using Statistical Package for Social Sciences SPSS (version 15) computer software and the results were presented in frequencies using simple percentages, tables and graphs. The Chi-square test was used to assess the significance where a p-value of <0.05 was considered statistically significant. In conclusion, Primary school pupils in Meru district engage in several risky sexual behaviors including substance use, sexual coercion, early sexual debut and engaging in various sexual practices. This calls for a more comprehensive approach in the fight against HIV among primary school children in Tanzania, which could include life skill training at an early age, behaviour change communication interventions, advocacy activities to influence policy formulation, condom promotion and incorporating key stakeholders in the rollout of school based HIV programmes such as parents, community leaders and faith-based organizations leaders. / South Africa

Despite the availability of the human papillomavirus (HPV) vaccine, African American women are still at risk for contracting HPV. This is significant because HPV is one of the main risk factors for cervical cancer. The purpose of this quantitative study was to explore the relationship between the use of HPV vaccination for cervical cancer prevention and personal history of HPV, reduced access to healthcare, and risky sexual behaviors in African American women. The theoretical framework used for this study was the health belief model (HBM). Two hundred twenty-nine (n=229) African American women living in the United States, ages 18-49, who participated in the 2013-2014 National Health and Nutrition Examination Survey (NHANES) were the sample under study. A univariate analysis was performed to describe the population and obtain frequencies and percentages for all covariates. A bivariate analysis was conducted to determine whether there was an association between any of the independent variables and the dependent variable. A multivariable logistic regression was conducted to build a predictor model for use of HPV vaccination. Women between the ages of 18 and 34 were 7.22 times as likely to receive the HPV vaccine as women aged 35-49 years, and this was statistically significant (OR: 7.22; 95% CI: 2.36 - 22.13). This study can contribute to positive social change within the community and public health profession through an increased awareness and knowledge of HPV and cervical cancer, especially for African American women.

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Current literature lacks longitudinal understandings of the association between childhood sexual/physical violence, alcohol use, depressive symptoms, and indiscriminant sexual behaviors among young women, as well as the racial/ethnic differences in these associations. Therefore, using the 1994-2008 National Longitudinal Study of Adolescent Health, this study examined a) heterogeneous growth trajectories of problem alcohol use during the transition from adolescents to young adulthood and the impact of childhood sexual/physical violence on drinking trajectories, b) the long-term impact of childhood sexual/physical violence on alcohol use and depressive symptoms, and c) the structural associations between childhood sexual/physical violence and indiscriminant sexual behaviors by examining alcohol use and depressive symptoms as mediators between White and African-American women. First, with 1,702 women, LCGM was used to identify trajectories of problem alcohol use using the first three waves. Four trajectories of problem alcohol use emerged: stable abstainers; decliners (moderate-low); incliners (low-moderate); and rapid incliners (low-high). From the bivariate level analyses, in reference to stable abstainers, White women who experienced childhood sexual/physical violence were more likely to be rapid incliners (low-high). Second, with 1,756 women, autoregressive cross-lagged path models were performed to test longitudinal associations between childhood sexual/physical violence, problem alcohol use, and depressive symptoms of White and African-American women. Both groups demonstrated significant association between childhood sexual/physical violence and subsequent development of depressive symptoms, while only White women demonstrated significant association with subsequent problem alcohol use. Third, with 1,388 women, SEM and multigroup SEM were used to test pathways between childhood sexual/physical violence and indiscriminant sexual behaviors for White and African-American women. SEM indicates that problem alcohol use and depressive symptoms mediated the proposed relationship. Multigroup SEM indicates that, for White women, both problem alcohol use and depressive symptoms mediated the association between childhood sexual/physical violence and indiscriminant sexual behaviors, while only depressive symptoms mediated the proposed association for African-American women. These findings highlight the importance of designing and providing effective prevention and treatment programs for women who experienced childhood sexual/physical violence to interrupt subsequent problem alcohol use, depressive symptoms, and indiscriminant sexual behaviors. / text

Since the early 1990s with the AIDS pandemic, there has been an increasing interest on the importance of risky sexual behaviors, especially among men who have sex with men (MSM). An important antecedent for these behaviors is alcohol use. Studies consistently show an increased frequency of both alcohol use and risky sexual behaviors in MSM populations. However, to date, there has not been a precise estimate of the effect size in these diverse populations and a consistent way to measure it. More so, the importance of context is often cited as a source of variability, but is rarely measured in these studies. Contextual factors are different and specific for MSM, as they have been approached by two theories, both of which will be guiding this dissertation: Singer’s Syndemic Theory and Meyer’s Minority Stress Theory. Chapter 1, then presents a comprehensive review of both theories as they apply to alcohol use, risky sexual behaviors, and contextual factors driving them. Chapter 2 answers the first research question about effect sizes through a systematic literature review. The effect sizes or measures of association of these contextual risk and protective factors were summarized using meta-analytic techniques. Using five electronic databases, we identified 26 studies in 26 years (1990–2015), all diverse in terms of sampling techniques, assessment of sexual orientation, operationalization of alcohol use and risky sexual behaviors, contextual factors included, and measurement of effect sizes. Despite this diversity, studies reporting an effect size were pooled and summarized using both descriptive and meta-analytic techniques, as appropriate. Meta-analyses were conducted using Cochrane’s guidelines for generic inverse variance outcomes with random effects. The pooled effects of alcohol use on condomless anal intercourse (CAI; OR 1.73 [95% CI 1.43, 2.10], I2 0%), heavy episodic drinking on CAI (OR 1.88 [95% CI 1.25, 2.81], I2 32%), and heavy episodic drinking on condomless oral sex (OR: 8.00; 95% CI 2.48, 25.81), as well as the effects of substance use, mental health status, violence and victimization, and self-reported HIV status as contextual factors in the pathway between alcohol use and risky sexual behaviors were calculated, reported, and discussed along with study limitations and implications for public health. Chapter 3 answers the second research question regarding a standardized measurement model for effect sizes and the multiple mediation of contextual factors. We used the male subset of Wave IV of the AddHealth dataset to test our hypotheses through structural equation modeling approaches, including measurement analysis with invariance testing, path analysis for direct effects, and multiple mediation analysis through bootstrapping for indirect effects. The AUD scale was invariant between MSM and MSW, but the risky sexual behavior scale was not. For MSM, the standardized direct effect of AUD onto risky sexual behaviors was –1.25 and the standardized total indirect effect of the multiple mediation model was 1.58, 95% CI [1.42, 1.73]. Among the mediators, the strongest indirect effect for any measured or latent mediator was the mental health construct (2.09). We conclude that even though AUD has the same measurement structure for MSM and MSW, its effect on risky sexual behaviors does not operate the same way for these two populations, supporting both causal and contextual behavioral theories. Conclusions are individually discussed, respectively, in Chapters 2 and 3. However, Chapter 4 puts both manuscript conclusions in context and further discusses future implications for public health research, practice, and policy.