Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Library wanting Figure 11 which is missing from manuscript. Typescript. Vita. Includes bibliographical references (leaves 102-120). Also available on the Internet.

Diss. Tromsø : Universitetet i Tromsø, 2006.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. Linköping : Linköpings universitet, 2008.

Master's thesis. / Format: PDF. Bibl.

Introduction: Mucosal human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) and is associated with genitals warts, anogenital cancers, and oropharyngeal cancers. Most sexually active persons will become infected with HPV at some point in their lives, however few will develop HPV-related diseases such as warts, lesions, or cancer as a result of the infection. It is unclear why a minority of individuals fail to clear HPV infection and develop clinical disease. Due to initial associations with cervical lesions, much research has focused on women. Th1 type immune responses have been associated with successful response to HPV infection. Factors such as psychological stress and sleep have been associated with immune function. Stress has been associated with cervical lesions, however no study has evaluated effects of stress or sleep on HPV infection. This research sought to examine the associations between perceived stress and sleep problems with HPV prevalence, incidence, and clearance among men. Methods: Men were tested for 37 individual HPV genotypes every 6 months as part of a large natural history study. A total of 426 men were followed over 1 to 4 visits. Perceived stress was measured with a modified 4-item Perceived Stress Scale (PSS-4) assessing stress in the past six months and was dichotomized into high (scores in the 4th quartile) and low perceived stress. Self-reported sleep problems were measured by seven likert-scale items and categorized as high (4th quartile of sleep problems scores), moderate (second and third quartiles; reference group), and low (first quartile). Three HPV classifications were examined; men were categorized as positive for 'Any HPV' if they tested positive for any of the 37 HPV genotypes in the study protocol, men were categorized as positive for 'Oncogenic HPV' if they tested positive for any oncogenic HPV type, and men were categorized as positive for 'Non-oncogenic HPV' if they tested positive for any non-oncogenic HPV genotype. In the prevalence analysis, men who had no detectable HPV infection with any of the 37 types were the reference group in all analyses. Prevalence ratios and 95% confidence intervals (95% CI) were calculated using Poisson regression with robust variance. For HPV clearance and incidence, Cox regression with the robust sandwich estimator was used to calculated hazard ratios and 95% confidence intervals. Results: A total of 424 men had genotyping results available for the prevalence analysis. High perceived stress was significantly associated with higher prevalence of any HPV infection [PR =1.33 (95% CI: 1.06-1.68)] and oncogenic HPV infection [PR=1.53 (95% CI: 1.06-2.20)], adjusting for demographics, sexual behavior, and sleep problems. High self-reported sleep problems was significantly associated with higher prevalence of oncogenic HPV infection [PR=1.50 (95% CI:1.01-2.13)], adjusting for demographics, sexual behavior, and perceived stress. Perceived stress and self-reported sleep problems were not associated with incidence of HPV infection. Perceived stress was not significantly associated with clearance of HPV infection overall. Among men 50 and older however, men with high stress were significantly less likely to clear any HPV infection than those with low stress adjusting for demographics, HR=0.09 (95% CI: 0.02-0.49). Compared to men with moderate sleep problems, those with high sleep problems were significantly less likely to clear an infection with any HPV type, HR=0.68 (95% CI: 0.49-0.94), or an oncogenic HPV type, HR=0.51 (95% CI: 0.28-0.94), after adjustment for demographics and perceived stress. Discussion: This is the first study to examine associations between HPV infection with perceived stress and self-reported sleep problems. It is also the largest study to examine associations between these exposures and an infection outcome. Results suggest that perceived stress and self-reported sleep problems have independent effects on HPV. Evaluation of perceived stress, biological indicators of stress, objective measures of sleep, and measurement of immune parameters may aid in further elucidating how stress and sleep disturbance are related to HPV infection. Determination of modifiable factors that can influence HPV infection may aid in the prevention of adverse disease outcomes related to infection with this virus. Examining the impact of factors such as perceived stress and sleep problems on HPV infection may aid in risk stratification of patients and allow more targeted interventions among those most at risk for developing disease.

Background HIV/AIDS has always been a concern since it first came up in 1981 in the field of medicine and public health. The trend of overall HIV epidemic has slow down through over 30 years fighting against the disease. Yet, being the largest population nowadays, young people still face high risk of HIV/AID. Sexual transmitted diseases, similar with HIV infection, are also a serious concern in young people. Peer education is widely used in the sexual education in young people. No review focused on the school-based peer education while most young people received their sexual education in schools. This systematic review aims to evaluate the effectiveness of school-based peer education on HIV/STD prevention and evaluate the factors that are likely to influence the effect of school-based peer education. Method Searching through PubMed and Cochrane Library, a literature review was carried out on the relevant articles about the evaluation of school-based peer education in developing and developed countries around the world from 2000-01-01 to 2014-05-31. Findings 10 experimental studies were chosen in this review, including 3 randomized controlled trials. Among 10 studies, 8 found significant improved about the general knowledge of HIV/STD and all studies showed positive change in attitude and risk perception in the peer-led education. However, no studies found significant effect of peer education on the behavioral change regarding condom use, postponing sexual intercourses and the reduction of sexual partners, etc. The interaction of peer education and the quality of peer-educators plus other demographical factors such as socioeconomic status and religions may influence the effect of school-based peer-led education. Conclusion School-based peer education was demonstrated to be effective on the prevention of HIV/STD in knowledge and attitude improvement, similar with other kinds of peer education. Peer educators and interactions between educators and educatees play important roles in the peer education. Yet, the effect of school-based education still requires long-term assessment. / published_or_final_version / Public Health / Master / Master of Public Health

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.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences