Sexual development and interest in sex is a normal part of adolescent development, but the negative outcomes of unprotected intercourse can result in life changing consequences such as an unplanned pregnancy or a sexually transmitted infection. Although the prevalence of these consequences have improvement over the past decade, the United States still has one of the highest teen pregnancy rates and highest prevalence of youth sexually transmitted infection among developed countries. In this report, the determinants that lead adolescents to engage in sex and fail to use contraceptives are reviewed. With knowledge on what factors contribute to adolescent sexual risk taking behaviors, counseling strategies can be implemented to prevent and intervene, and the school counselor is in a prime setting for delivery. The prevention strategies that are covered in this review are grouped into five categories. They are education, skill building, enhancing student development, involving parents and families, and implementing programs. / text

Background: The sexually transmitted infections (STIs), chlamydia and gonorrhea, disproportionately affect racial and ethnic minorities. Community attributes like poverty and prevalence of STIs, along with residential segregation and its impact on composition of sexual networks contribute to these disparate rates. The Southeast had the highest rates of chlamydial and gonorrheal infection among the four regions of the United States. Because relationships between race and place can confound national statistics, it is important to examine whether racial disparities within the region are associated with higher rates of infection. Purpose: The study aims to evaluate local geospatial clustering of gonorrhea and chlamydia rates in the Southeast, and their persistence during 2000-2005 and any associations with residential segregation, income inequality, unemployment and uninsured rates, and race. Methods: Using the Local Indicators of Spatial Association tests of spatial clustering, cluster maps were created for each STI outcome and year. Independent sample t-tests were then used to examine the difference in means of each community level variable across counties composing the high-rate clusters and all other counties in the region. Results: Over 60% of counties composing high-rate clusters persisted as high rate clusters over time, and were significantly associated with higher levels of community disadvantage than all other counties (p < 0.01). Overall gonorrhea rates decreased from 2000 to 2005 and chlamydia rates increased, while their associations with community disadvantage remained persistently strong over time. Conclusions: Counties with higher rates of chlamydia and gonorrhea persist over time and experience persistently higher levels of residential segregation and income inequality, as well as higher unemployment and uninsured rates, and higher proportions of blacks in the population. The social environment and segregated sexual networks may play important roles in the persistently high rates of chlamydia and gonorrhea observed for certain regions within the Southeast. Continued surveillance of reportable STIs and their probable predictors is needed in order to better understand the persistent disparities in STI rates across counties in the Southeast.

Könssjukdomen klamydia är bland de vanligaste könssjukdomarna i världen. Könssjukdomen är anmälningspliktig och det ingår sjuksköterskans profession att arbeta preventivt med bland annat provtagning och smittspårning för att ständigt förebygga smittan. Syftet med denna litteraturstudie är att belysa unga vuxnas upplevelser av att testa sig för könssjukdomen. Författarna har analyserat nio vetenskapliga artiklar som resulterat i två huvudkategorier och fem underkategorier. Den första kategorin samt underkategorierna till denna var följande: Vårdrelaterade upplevelser av klamydiatestning; En känsla av okunskap; Känsla av tillit till vårdarna. Kategori nummer två löd: Psykosociala upplevelser av klamydiatestning med underkategorierna; ”Andra” människors problem; Risk för stigmatisering; Ett moraliskt ansvar. Resultatet visade att det hos unga vuxna fanns brist på kunskap kring könssjukdomen klamydia och testning kring denna. Vårdpersonalen hade i samband med testning stor inverkan och kunde påverka unga vuxnas val kring vart testet föredrogs att utföras samt av vilken befattning. Könssjukdomen visade sig också vara stigmatiserad och kunde skada relationer samt väcka känsla av skuld och skam. Litteraturstudien bidrar med att synliggöra unga vuxnas upplevelser kring testning vilket medför möjlighet för vårdpersonal att förbättra bemötandet så att en god vård kan erbjudas.

Sexually transmitted diseases (STDs) continue to remain a public health concern in the United States, especially among young people. Levels of knowledge with regard to STDs have been investigated in prior research; however, these investigations have been limited primarily to older adolescents and young adults. Grounded in the social cognitive and subjective culture theories, this quantitative, cross-sectional study assessed STD knowledge (other than HIV/AIDS) among 7th grade students attending a public middle school in the United States. Demographic differences (age, gender, and ethnicity) in STD knowledge were examined to determine if these demographic variables predict STD knowledge scores and if the Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ) is a valid and reliable instrument among this study population. Chi-square analysis demonstrated that STD knowledge scores significantly differed by age only: Twelve-year-olds had higher STD scores than did 13-year-olds, contrary to research in older adolescents, which may be the result of confounding factors that warrant further investigation. Multiple regression analysis showed that age, gender, and ethnicity were not associated with STD knowledge scores. The STD-KQ was found to have face validity as well as high consistency and reliability among all questions related to STDs other than HIV/AIDS using Crohnbach's alpha. Content validity for individual STD-KQ items was shown using Lawshe's content validity ratio and subject matter experts. Results of the study support positive social change and highlight the need for earlier STD education, other than HIV/AIDS, with middle school children and the need to examine other factors that may impact STD knowledge within this age group.

Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) is a national priority for several reasons including its endemic/pandemic status and economic demand. Adolescents 15 to 24 years old who are sexually active acquire nearly half of all new Sexually Transmitted Infections (STIs). Recent findings from the Centers of Disease Control (CDC) have documented increased teen birth rates, escalating births to unwed mothers, and STIs ascribed to one in four adolescent females, are reasons to enhance effective prevention efforts. The specific aim of the study, based on Bandura's social cognitive theory, was to test associations among communication system methods and HIV/AIDS self-efficacy, perceived risk, knowledge, and sexual decision-making among older adolescent females. Communication systems consist of interpersonal relationships, mass and print media. Research questions are: (1) What are the associations among demographic variables (age, race/ethnicity, education, socioeconomic status) in young women and the types of communication systems preferred (media and interpersonal)? (2) What are the associations among the types of communication systems preferred by young women and person factors (HIV/AIDS self-efficacy, perceived risk, and knowledge)? (3) What are the associations among the types of communication systems preferred by young women (media, print, interpersonal) and behavior (sexual-decision making)? (4) What are the associations among young women's person factors (HIV/AIDS self-efficacy, perceived risk, knowledge) and behaviors (sexual decision-making)? The study used a non-experimental cross sectional design. The sample included 866 females, 18 to 21 years old, attending the the second largest public university or a historically black university in Florida. Data was collected using validated instruments transcribed into an electronic survey program. Data analysis consisted of frequency distributions, descriptive statistics, and Multiple Regression Analysis. Results indicated that there were associations beween all proposed constructs that constitute the theoretically derived conceptional model. Interpersonal relationships explained the most variance (parents--22%; partners-12%) when associated with other communication systems. Overall, students reported that parents had more influence on their decisions with regards to basic beliefs, value systems, sexuality, dating, and alcohol use. The communication systems associated with older adolescents' sexual decision-making may assist public health advocates in developing related preventive interventions for young adult females.

Young people are at risk of sexually transmitted infections (STI), and engage in sex and drug related risk behaviour. This thesis investigates novel methods to reach youth for research and health promotion. Mobile phone text messages (SMS) are convenient, low cost, fast, and popular among youth. SMS has been utilised in sexual health for clinical management, service delivery and health promotion, but few of these projects have been evaluated. Recognising this lack of research led to the design of a randomised controlled trial investigating the use of SMS and email in sexual health promotion. Recruitment of young people for this trial was piloted at Melbourne’s Big Day Out. 939 young people were recruited in several hours; 30% were classified as being at high risk of STI, and 46% had used illicit drugs in the month prior to the survey. Knowledge of STI was poor. Drug use was associated with both sexual risk behaviour and music preference. The study demonstrated that this festival is a valuable site for sex and drugs research and health promotion. The following year, young people were recruited at the music festival and randomised to an intervention group who received regular sexual health SMS and email, or a control group who received no messages. After 12 months, the intervention group had higher STI knowledge than the control group (OR 2.72, 95%CI 1.68, 4.41) and intervention group females were more likely to have had an STI test (OR 2.51, 95%CI 1.11, 5.69). Respondents’ opinions of the messages were favourable. This simple, low-cost, and novel method was shown to be effective in improving young people’s sexual health. At-risk young people are not well represented in sex and drug behavioural surveillance in Australia. As the pilot study identified that a music festival was a suitable site for sex and drug research, the survey was repeated each year. Between 2005 and 2008, the proportion of young people at risk of STI decreased from 34% to 29%, and recent illicit drug use decreased from 46% to 43%. A limitation of the studies described herein is reliance on self-report, which is subject to recall bias; this can be reduced using diaries to collect behavioural data. Participants completed weekly diaries of sexual behaviour and a retrospective questionnaire. Correlation between the diaries and questionnaire was substantial, adding confidence to the validity of results of other studies in this thesis. Diaries can be collected in different ways; SMS has not previously been used for this purpose. Participants were randomised to complete diaries through SMS, online or paper. Online diaries were superior to SMS in completeness and participant preference, but SMS diaries were more likely to be submitted on time. This thesis has tested several novel options for researching and promoting health to young people. Through music festivals, SMS, and email, young people can be reached through settings and media they are familiar with. Use of these novel methods has increased understanding of risk behaviour among youth and been effective in sexual health promotion.

Good sexual and reproductive health is fundamental to the overall health status of Māori communities. In 2001, the Ministry of Health reported that New Zealand was facing a Chlamydia epidemic. This epidemic has not abated as rates of Chlamydia have increased significantly in the past five years, with disproportionately high rates in young Māori women compared to non-Māori women. Despite significant sexual health disparities, young Māori have had limited opportunities to participate in research focussed on sexual health and voice their opinions and concerns on sexual health issues. This qualitative descriptive study has used a Māori inquiry paradigm and approached the research from a Kaupapa Māori perspective. The primary research question asked what the knowledge, attitudes and reported behaviours of young urban Māori women were in regards to sexual health and in particular, the sexually transmitted infection Chlamydia. Secondary aims were to ascertain the sources of information used and accessibility of sexual health services, as well as identifying resilience factors associated with protection against Chlamydia infection. The data was collected from semi-structured interviews with 16 young Māori women living in the Auckland region. Data analysis involved the inductive approach of categorical content analysis to identify major categorical themes to answer the specific questions posed. The main conclusion was that there are a number of barriers to accessing quality sexual health information and services for young Māori women. Participants’ level of knowledge varied reflecting their personal experiences and many were unaware that Chlamydia is asymptomatic and that delayed diagnosis can lead to fertility problems. The main sources of sexual health information accessed were whānau, peers, school, and contact with health professionals. Racism was identified as one of the barriers to sexual healthcare services. The young women expressed a clear preference for sexual health services to be delivered by Māori. Most importantly, for sexual health interventions to be successful it is essential that Māori communities, including young people and their whānau, are an integral part of creating positive solutions. Resilience factors that may help protect young women from contracting chlamydia characteristic of this group were having a strong connection with a caring adult or friend and parents who viewed sexuality as a normal part of adolescent development. In addition, having a positive Māori cultural identity with an ability to understand bicultural differences was strongly associated with participants accessing sexual healthcare services despite identified barriers.

This thesis presents data on two separate areas relevant to the prevention of HIV and sexually transmitted infection (STI) transmission in homosexual men. These data arise from the community-based Health in Men (HIM) cohort of HIV-negative homosexual men in Sydney. First, the association of circumcision status with HIV and STIs was examined. Older age, ethnicity and country of birth were demographic factors independently associated with circumcision status. Self-report was a valid measure of circumcision status in this population. Overall, being circumcised was associated with a non-significant reduced risk of HIV seroconversion in the HIM cohort (HR 0.76, 95% CI 0.41-1.41, p=0.381). Among the one-third of participants predominantly practising the insertive role in anal intercourse (AI), being circumcised was associated with a significantly reduced risk of HIV infection (HR 0.15, 95% CI 0.03-0.80, p=0.026). Circumcised HIM participants also had a lower risk of incident syphilis (HR 0.35, 95% CI 0.15-0.84, p=0.019), however circumcision status had no significant effect on the remainder of prevalent and incident STIs examined. Second, risk factors for pharyngeal gonorrhoea and chlamydia were investigated. The BD ProbeTec nucleic acid amplification test (NAAT) had a positive predictive value (PPV) for pharyngeal gonorrhoea diagnosis of only 30.4% (95% CI 25.2-36.1%) when compared to a previously validated NAAT targeting the gonococcal porA pseudogene. Pharyngeal gonorrhoea was common in HIM, mostly occurred without concurrent anogenital infection and may frequently spontaneously resolve. Infection was independently associated with younger age (p-trend=0.001), higher number of male partners (p-trend=0.002), contact with gonorrhoea (p<0.001) and insertive oro-anal sex with casual partners (p-trend=0.044). Pharyngeal chlamydia was less common but a high prevalence/incidence ratio suggested that infection may persist in the pharynx for long periods. Pharyngeal chlamydia was independently associated with receptive penile-oral sex with casual partners (p-trend=0.009). In conclusion, circumcision may have a role as an HIV prevention intervention among the subgroup of homosexual men who predominantly practise insertive rather than receptive AI. Regular screening of the pharynx including a validated supplemental NAAT for gonorrhoea diagnosis may prevent much transmission to anogenital sites, whereas chlamydia occurs too infrequently in the pharynx to recommend routine screening in homosexual men.

This paper explores some of the factors that influence whether African American female college students implement safe sex knowledge. High rates of HIV/AIDS and other sexually-transmitted infections (STIs) in the black community and the overrepresentation of individuals under the age of 25 in sexually-transmitted infection (STI) reports indicate the need for research that investigates the physical, social, and cultural aspects of high-risk sexual behaviors and the factors that influence them for this group. African American female college students present a unique challenge to sexual health educators; a challenge that has been relatively under acknowledged and under addressed in research and scholarly literature. This omission from research is likely the result of assumptions that suggest that the structural barriers that greatly impact the use of sexual health knowledge in low-income African American women do not exist for female college students from the same racial/ethnic background. However, focus group and survey data, collected during this study, suggest that this group may in-fact share some structural barriers with low-income African American women since financial and cultural barriers that may have existed in their communities do not necessarily become obsolete upon entering college.

Background: Unintended pregnancy and sexually transmitted infections among young people are priority public health issues in the UK. Social marketing is the preferred Government approach to intervention despite limited evidence on efficacy. There is need to understand its applicability and effectiveness in addressing the specified sexual health issues. Methods: Three studies were carried out, of which the first was a systematic review of 12 studies assessing the effectiveness of social marketing in reducing unintended teenage pregnancies. The second and third were consumer research applications examining factors associated with Long Acting Reversible Contraceptive (LARC) use and Chlamydia screening respectively. The second study involved analysing five ONS Contraception survey datasets while the third involved analysing Havering PCT Chlamydia screening records and qualitative data from 28 participants. Data were analysed using Stata.10 and Framework statistical packages and maps drawn using MapInfo.10.5. Results: The systematic review showed that nine studies achieved significant effects on at least one of the specified outcomes (reduced pregnancy rates and related behaviour changes). The second study showed that the NICE guidelines published in 2005 successfully addressed the disparity in LARC uptake previously experienced by women aged below 20. The third study identified females and non-white participants as more likely to take Chlamydia tests. Motivating factors for testing included convenient access to kits and fear of infertility, while barriers included ignorance and fear of results. Conclusions: Social marketing appears to be effective in reducing unintended teenage pregnancies but evidence is limited to particular outcomes and context. Consumer research provides vital intelligence about target populations necessary for designing effective interventions and addressing inequalities. However to assess its influence on outcomes, studies that feature all social marketing components are required. Overall there is need for more studies that specifically utilize social marketing principles to enable more robust evaluations.