Thesis (M. P. A.)--Texas State University-San Marcos, 2008. / "Summer 2008." Includes bibliographical references (leaves 56-62).

As breast cancer survival rates increase, quality of life issues should be addressed, specifically regarding sexual health. Breast cancer treatment can lead to sexual dysfunction, alterations in sexual self-concept, body image, self-esteem, and relationship issues which can cause a depressed quality of life. These sexual health issues can also uniquely affect the intimate partner. It appears that a strong relationship and supportive intimate partner can protect against the stressors due to these sexual problems. Addressing sexual concerns, whether physical, psychological, or relational are a clear necessity in managing the care of patients with breast cancer, regardless of partner status, age, or disease stage. Clinicians and medical professionals should address these issues in patient care plans, examinations, and patient education, focusing not only on the patient but also on the couple as a unit. However, there are barriers to communication in regards to sexuality on both the part of the physician and the patient that cause a discrepancy between available resources and patients actually receiving them. Developing effective treatment plans and interventions are essential in improving the quality of life in women suffering from physical, psychological, and relational sexual issues due to the management of breast cancer.

Sexual health risk-taking behaviour is typically initiated during adolescence and continues throughout teenage years and early adulthood at higher levels than at other life stages. For some groups (e.g. deprived and vulnerable populations) the risks can be greater still. Risk behaviours in early youth are related to increased rates of risk-taking and the adoption of multiple risk behaviours in early adulthood. Prevention interventions implemented early on are shown to be most effective at preventing or reducing the poor health outcomes associated with risk-behaviours. Policies and prevention interventions are informed by current data showing patterns of risk behaviour, identification of emerging behaviour, factors associated with these behaviours and evidence of intervention prevention effectiveness. This submission presents a linking commentary which summarises and critiques a series of peer reviewed publications, supported by additional publications, all of which were carried out during my employment at Liverpool John Moores University. Studies have identified key factors affecting sexual development and associated behaviour; associations between sexual and other behaviours, such as alcohol behaviours; and the relationship between social and well-being factors and sexual behaviours in adolescents and young people. Studies also evaluate public health initiatives and review public health evidence of intervention effectiveness. These studies have contributed to understanding sexual development and its impact on behaviours during the life course; have highlighted the health service and education needs of young people; and have identified effective interventions and intervention components to inform national guidance, public health policy and intervention development.

O presente estudo teve como tema a saúde sexual da mulher. O objetivo desse estudo foi saber o que é e como se dá o cuidado para mulheres que são prostitutas. Quis lidar com esta população, considerando que assim como outras mulheres de outras profissões, estas estão suscetíveis a qualquer infecção sexualmente transmissível. Além disso, quis saber se há diferença no tratamento dado a elas em suas consultas ginecológicas, se elas recebem mais orientações quanto aos métodos preventivos de ISTs do que outras mulheres que não são prostitutas. Para tanto realizou-se pesquisa qualitativa com a utilização de entrevistas face a face, com o emprego de um roteiro semiestruturado junto a prostitutas do baixo meretrício na região central da cidade de Santos/SP. As entrevistas foram gravadas, transcritas e os depoimentos de acordo com a análise temática. Foram entrevistadas 11 mulheres com 19 a 59 anos de idade. O cuidado para essas mulheres de forma geral diz respeito ao uso do preservativo masculino com seus clientes, à realização de exames, higiene corporal, ao falar de suas profissões aos profissionais de saúde e também de suas identidades de gênero. Foi observado que as mulheres abordadas nessa pesquisa não receberam orientações específicas referentes a medidas preventivas em saúde, a maioria disse não ter recebido nenhuma informação de seus pais, escola ou serviços de saúde quanto à prevenção de gravidez e ISTs antes da primeira relação sexual. É importante ressaltar que a primeira relação sexual de três das onze entrevistadas foi fruto de estupro na infância, o que contribuiu com a falta de cuidado para com elas mesmas, desde sua infâncias. A grande maioria delas não utiliza o preservativo feminino. No entanto, foi observado que o cuidado para elas, não inclui somente o cuidado com o corpo, com o biológico. Elas em suas falas citam o cuidado com os filhos, com os pais e até presenciei uma situação de cuidado voltada a mim por uma das participantes. Além disto, também identifiquei o meu cuidado para com elas, quando as dei minha atenção e olhar. / The present study had as its theme the sexual health of women. The purpose of this study was to know what care is and how to care for women who are prostitutes. I wanted to deal with this population, considering that like other women in other professions, they are susceptible to any sexually transmitted infections. She also wanted to know if there is a difference in the treatment given to them in their gynecological consultations if they receive more guidance on STI preventive methods than other women who are not prostitutes. Qualitative research was carried out using face-to-face interviews, using a semi-structured script with low-income prostitutes in the central region of the city of Santos / SP. The interviews were recorded, transcribed and the statements according to the thematic analysis. We interviewed 11 women aged 19 to 59 years. The care for these women in general refers to the use of male condoms with their clients, to perform examinations, body hygiene, talking about their professions to health professionals and also their gender identities. It was observed that the women addressed in this research did not receive specific guidelines regarding preventive health measures, most of them said they had not received any information from their parents, school or health services regarding pregnancy prevention and STIs before the first sexual intercourse. It is important to emphasize that the first sexual relation of three of the eleven interviewees was the result of rape in childhood, which contributed to their lack of care for themselves since their infancy. The vast majority of them do not use the female condom. However, it was observed that the care for them does not only include care with the body, with the biological. They in their statements cite the care with the children, with the parents and even witnessed a situation of care directed to me by one of the participants. In addition, I also identified my care for them when I gave them my attention and look.

This dissertation study utilized the National Longitudinal Study of Adolescent to Adult Health to analyze empirical relationships between social determinants of health and adolescent pregnancy. Although rates of adolescent pregnancy are at an all-time low in the United States, disparities persist. Examining relationships between the social determinants of health and adolescent pregnancy provides support for funding and interventions that expand on the current focus of individual and interpersonal level factors. Based on the Healthy People 2020 Social Determinants of Health Framework, proxy measures for social determinants of health were identified within the Add Health study and analyzed in relationship with adolescent pregnancy. Results indicated that six of 17 measures of social determinants of health had an empirical relationship with adolescent pregnancy. These measures included the following: feeling close to others at school, receipt of high school diploma, enrollment in higher education, participation in volunteering or community service, litter or trash in the neighborhood environment, and living in a two parent home. The results of this study can inform future research, allocation of funds and interventions based on social determinants of health that show an association with adolescent pregnancy.

Background: A critical component of sexual health is healthy sexual functioning; being able to experience sexual enjoyment and satisfaction when desired. Sexual difficulties are not unusual and can have either physical or psychological causes. An estimated 100 million males worldwide suffer from erectile dysfunction (ED), with the expectation that this sexual problem will increase to 322 million cases by the year 2025 (Bacon, Mittleman, Kawachi, Giovannicci, Glasser, & Rimm, 2003). The prevalence of ED greatly escalates in older males and those with Cardiovascular Disease, Hyperlipidemia, and Diabetes due to related endothelial dysfunction (Bivalacqua, Usta, Champion, Kadowitz, & Hellstrom, 2003). Sexual dysfunction is a concern for all males, including those over the age of 65. Because sexual function or sexuality is a critical factor contributing to the quality of life among older adults (Gelfand, 2000; Robinson & Molzahn, 2007), attention to sexual dysfunction is needed to ensure a high quality of life among older adult males (Vincent & Velkoff, 2010). Furthermore, psychological and emotional stress have been associated with sexual dysfunction among males; both as a cause and a result of this condition. Purpose: The purpose of this study was to determine the level of distress associated with perceived stress and sexual function among community-dwelling older adult males in stable relationships. Study Aims: The study aims are to 1) describe perceived stress and sexual function in a community-dwelling older adult male population, 2) describe the relationship between perceived stress and sexual function, and 3) describe the relationship between perceived stress and sexual function while controlling for individual characteristics of the sample. Methods: A descriptive, cross-sectional research design was used. The sampling technique was a convenience sample of males aged 65 and older enrolled in a university affiliated lifelong learning institute in the southwestern United States. Inclusion criterion consisted of independent, active males aged 65 and older, in addition to being able to speak and read English. Exclusionary criterion comprised of those who have cognitive impairment determined by an Abbreviated Mental Test Score (AMTS) of six or less. Results: The majority of the 92 participants were between the ages of 65-70 and Caucasian. Overall, the sample was highly educated with most holding an Associate college degree or more advanced degree, was married, in age-related retirement, currently not working, and considered them self financially within the middle to higher middle-income level. Over half declared they have had sexual activity in the last month with an average level of sexual functioning and above average level of sexual satisfaction. In general, the participants indicated they are not stressed. There is a significant and negative correlation between perceived stress and sexual function (satisfaction). There is a significant relationship between perceived stress and Obesity with sexual function (erection, ejaculation, and satisfaction). Significant univariate effects were found on age with sexual function (erection, ejaculation, and satisfaction). Furthermore, significant univariate effects were found on Obesity with sexual function (ejaculation and satisfaction). Subsequently, a significant univariate effect was found on Cancer with sexual function (satisfaction). Significance: These study findings may serve as a foundation for enhancing sexual function; thus, establishing improved sexual health and quality of life among older adult males.

The prevention of sexually transmitted infections (STIs) continues to be a significant challenge to public health in the United States. While educational institutions, health professionals, and community outreach programs have helped the rates of transmission on local, national, and global scales, we are still seeing a rise in contraction and spreading of these infections. Half of these STI cases are from individuals ages 15 -24 years of age. For that reason, we must explore why this age group has the highest cases of STI rates (Centers for Disease Control and Prevention [CDC], Sexually Transmitted Disease Transmission 2015). The focus of this project is to explore the relationship between sex education programs in Georgia public schools and their contribution to rise in STIs in this state. Here I argue that the curriculum of these programs affect students in numerous ways through teaching concepts, curriculum choices, romanticized ideology of sex, scare and shame tactics, and inaccurate information. With the consideration of these factors and student testimony, the sex education programs’ contribution to the high rates of STIs in Georgia are assessed.

Since the early 20th Century, epidemiological research has brought benefits and burdens to Aboriginal communities in Canada. Many First Nations, Métis, and Inuit continue to view Western research with distrust; quantitative study methods are perceived as especially inconsistent with indigenous ways of knowing. There is increasing recognition, however, that rigorous epidemiological research can produce evidence that draws attention, and potentially resources, to pressing health issues in Aboriginal communities. The thesis begins by introducing a framework for culturally safe epidemiology, from the identification of research priorities, through fieldwork and analysis, to communication and use of evidence. Drawing on a sexual health research initiative with Inuit in Ottawa as a case study, the thesis examines cognitive mapping as a promising culturally safe method to reviewing indigenous knowledge. Juxtaposing this approach with a systematic review of the literature, the standard protocol to reviewing Western scientific knowledge, the thesis demonstrates the potential for cognitive mapping to identify culturally safe spaces in epidemiological research where neither scientific validity nor cultural integrity is compromised. Modern epidemiology and indigenous knowledge are not inherently discordant; many public health opportunities arise at this interface and good science must begin here too.

The 2010 elections in Myanmar installed the country’s first civilian-elected government in more than 50 years, and subsequent growth and change have been rapid. However, reproductive health indicators are generally poor and reflect significant regional and geographic disparities. Rural populations are increasingly migrating to urban centers, like Yangon, in search of better economic opportunities and in response to persistent conflict. Many are settling in peri-urban Yangon, a dynamic series of townships characterized by poor infrastructure, slums, and a highly mobile population. However, very little is known about the reproductive health needs of this population. This study was designed to identify the reproductive health needs of women in peri-urban Yangon, and to understand better current practices, available services, and potential avenues for improvement. My research focused on delivery care, contraception, abortion, and post-abortion care. Using a multi-methods approach, and standard qualitative analytic techniques, I identified significant unmet reproductive health needs in peri-urban Yangon. The findings suggest that reproductive health services are often available but inaccessible. Findings demonstrate considerable misinformation, common and unsafe practices surrounding abortion and delivery, and a dearth of comprehensive sexual and reproductive health services for adolescent and unmarried populations.

In a study we conducted with Ontarian women about their abortion experiences (OAS), one third of participants expressed a desire for post-abortion support. Yet, there is some anecdotal evidence to suggest that organizations offering these services are using judgmental frameworks. In order to rigorously investigate this, we explored what post-abortion support services are offered across the province of Ontario. This multi-methods study included an analysis of OAS data, creating a directory of post-abortion support services in the province, conducting an analysis of how these services represent themselves online, and carrying out mystery client interactions. We found that the majority of organizations offering post-abortion support services in Ontario are crisis pregnancy centers. The services offered at these organizations are built upon frameworks that are both shaming and stigmatizing of abortion experiences. Efforts to increase the online visibility and overall accessibility of non-judgmental, medically accurate post-abortion support services in Ontario appear warranted.