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Text in English / Many African countries including Zimbabwe have scaled up and included male circumcision in their comprehensive HIV Prevention package. However, the impact of male circumcision on male sexual function and satisfaction has remained controversial. The main purpose of the study was to investigate the impact of male circumcision on sexual function and satisfaction in Harare, Zimbabwe. A quantitative study was carried out amongst a sample of 169 circumcised men using a questionnaire. The results showed that circumcision has a positive effect on both male sexual function and satisfaction. It was concluded that undergoing voluntary medical male circumcision have a high degree of satisfaction with the procedure and its consequences in terms of sexual function and satisfaction. It was recommended that men are educated about these findings so as to clear myths and misconceptions around circumcision. / Health Studies / M.P.H.

Le propos de la thèse est d’étudier le traitement social de la sexualité des personnes désignées comme « handicapées mentales » en Suisse et en France, par le biais d’une enquête qualitative réalisée par entretiens avec des personnes considérées comme « handicapées mentales », des parents, des éducateurs spécialisés et des assistants sexuels.Une première partie étudie les représentations des personnes désignées comme « handicapées mentales » au sujet de la sexualité et met en lumière des formes de leur vie sexuelle, souvent commentée mais qui restait inexplorée. Puis, la deuxième partie porte sur l’analyse des représentations et des pratiques institutionnelles et parentales relatives à l’accompagnement de la sexualité des personnes « handicapées mentales » dans le contexte actuel de la « santé sexuelle ». Enfin, la troisième partie de la thèse est consacrée à l’étude de l’assistance sexuelle telle que cette activité est récemment apparue en Suisse.En mobilisant le handicap mental et la sexualité comme des révélateurs mutuels, cette recherche se donne ainsi pour objectif d’analyser comment les différentes catégories d’acteurs impliqués dans l’accompagnement de la sexualité des personnes « handicapées mentales » co-construisent les normes qui régissent la vie sexuelle de ces dernières. Elle vise à offrir une étude la plus complète possible du traitement social de leur sexualité et des logiques qui le sous-tendent. / The subject of this dissertation is to study the social construction of the sexuality of people labelled as « intellectually disabled » in Switzerland and in France by means of a qualitative survey realized through interviews with persons considered as « intellectually disabled », parents, specialized educators and sexual assistants.A first part deals with the analysis of the representations of persons labelled as « intellectually disabled » regarding sexuality and with bringing to light the forms of their sexual life, often commented but still unexplored. The second part aims at analyzing the institutional and parental representations and practices towards the sexuality of people considered as « intellectually disabled » in the current context of « sexual health ». Finally, the third part of this dissertation studies the recent activity of sexual assistance in Switzerland.By mobilizing intellectual disability and sexuality together, this research aims at analyzing how the different categories of actors implied in accompanying « intellectually disabled» people in their sexuality co-build the norms that govern their sexual life. It aims at proposing a complete study of the social treatment of their sexuality and the logics that underlie them.

Parent-child sexual health communication (PCSHC) can have a positive impact on adolescents’ sexual health choices, outcomes, and capabilities for communicating with others about sexual health. Many parents are hesitant and feel unprepared for and uncomfortable with communicating about sexual health with their children. Other parental factors as well as child factors can impact the quality, frequency, coverage, and effectiveness of PCSHC. Some adolescent sexual health outcomes have improved, however, teen birth rates in the United States are elevated compared to other developed countries and half of all sexually transmitted infection (STI) diagnoses are made to adolescents and emerging adults. This emphasizes the importance of PCSHC as a protective factor for children and opportunity for them to develop understanding and skills for good sexual health decision-making. While challenging to recruit and retain participants, parent sex education programming designed to promote PCSHC can instill a sense of parental necessity and responsibility, and equip parents with knowledge and skills to confidently and successfully engage their children. The theory of planned behavior (TPB) provided the framework for this mixed methods study designed to learn more about PCSHC, differences in PCSHC based on gender of children, parental beliefs about PCSHC, intentions for and actual engagement in PCSHC. Included in the literature review for this study is a systematic review of literature focused on parent education programming designed to improve PCSHC. Parents of children in grades 4 – 11 completed a pencil/paper or an electronic Qualtrics baseline survey containing questions about their perceptions of and engagement in PCSHC. The quantitative data collection instrument included items measuring TPB constructs of behavioral, normative, and control beliefs, intentions for and actual engagement in PCSHC and condom use instruction delivery, communication openness, communication ability, sexual health topics discussed with children, and respondents’ demographics Many of the respondents (N = 205) were residents of the program target community, Winchester/Clark County, Kentucky, and were eligible to participate in parent programming, as were all residents that were parents of children in grades 4 – 11. The program, I’ll Have a Side of Sex Education, was designed as a six-week series of 50 minute lunch time sessions with the intention to improve parents’ sense of comfort, confidence, and skills in communicating with their children in general, and particularly about sexual health. Of the 205 parents who completed the baseline survey, 50 enrolled in and attended some or all of one of five offerings of the six-week parent education series and were invited to complete a post-program and six-week follow up surveys. Post-program data were collected with a paper- pencil survey and six-week follow up data were collected with a Qualtrics survey. The systematic review of parent sex education literature provided insight into components of programming related to successful program delivery and positive parental outcomes. The systematic analysis of the baseline data including examining PCSHC factors from the parental perspective and how these related to the gender of children and determining the usefulness of the TPB constructs for understanding PCSHC Results of Chi-square tests of mean differences showed a significant difference in parents actually providing their children with instructions for correct condom usage, χ2(2, N = 203) = 6.96, p = 0.03, and MANOVA results revealed the degree to which parents address certain sexual health topics with their children related to the gender of their children. Results of logistic regression showed behavioral beliefs having the greatest predictive power of parents’ intentions to give condom use instructions (p < 0.01) and actual delivery of condom use instructions (p = 0.04) and engagement in PCSHC, generally (p = 0.03). The current study contributes to the greater body of literature addressing parental and child factors related the promotion, delivery, and effectiveness of PCSHC and parent education programming designed to improve the quality, frequency, and impact of PCSHC. Its findings expand our understanding of how gender of children and parental beliefs relate to PCSHC and lend themselves to the consideration of the greater social influences impacting parents’ ability and motivation to engage their children in communication about sexual health. Differences in communication based on gender of children signal to a double standard in the messaging about sexual health and behaviors related to gender and these discrepancies leave adolescents and emerging adults, both males and females, vulnerable at worst to poor sexual health choices and outcomes and at least to being undereducated about sexual health topics. Although these findings give little support for the overall TPB model contributing to the understanding of parental intentions and behavior related PCSHC, the relationship between behavioral beliefs informed by attitudes about the value of PCSHC and parental intentions and behaviors does provide insight to health promoters and educators. Assessing parental attitudes toward PCSHC and tailoring messages and educational opportunities that may improve these attitudes and motivate parents to engage in and seek support for effective PCSHC holds promise. The piloting of a parent education program adapted from a previously evaluated parent sex education programming and the summative evaluation offered by participants gives support for efforts on the part of health promotion and education professionals to invest time, energy, and resources into program design and delivery and recruitment and retention of parents.

Background: Sexual consent is often defined as the voluntary agreement to participate in a sexual act, though the differing definitions across and within countries make legal consensus difficult. In recent years, due to popularization through social media, nonconsensual condom removal, termed stealthing, is becoming common, especially among young adults. Yet, little to no empirical evidence exists on this sexual behavior. Methods: In this exploratory sequential mixed methods approach, we aimed to address the current perception of stealthing among young adults. College students were recruited from general education courses at a medium-sized four- year public university. Focus groups were conducted to understand the current perception of stealthing, including knowledge, perceived influence, and outcome, followed by quantitative assessment of knowledge, attitude, and self-efficacy of sexual consent. Results: Results demonstrated central theme of health-decision making with associated themes of consent, which further included subthemes of privacy, trust, and violation, followed by consideration of stealthing as sexual assault and social norm and acceptance of stealthing. Quantitative assessment showed that knowledge and awareness of stealthing remains low, though sex differences exist on the perception of stealthing being considered sexual assault; with higher rates among males as compared to females. Conclusion: The act of stealthing has been popularized in social media. Our results demonstrate that there is a need for health educators to assess the prevalence of such a behavior among young adults and policy makers to assess the legal implications of nonconsensual condom removal.

Latinas/os are one of the fastest growing and most heterogeneous minority ethnic groups in the US. One in 5 women in the US are Latina; by 2060, it is projected that Latinas will compose 1/3 of the female population. Latinas continue to experience disparities in sexual and reproductive health outcomes compared to non-Hispanic whites. While factors impacting undesirable consequences of sexual activity for Latinas have been well documented, Latinas' experiences with sexual satisfaction in the broader context of sexual health remains understudied, despite sexual satisfaction having been identified as an integral component of sexual health. A focus on positive sexual health outcomes for Latinas has the potential to challenge known stereotypes about Latina sexuality; specifically, those related to cultural constructs such as acculturation, machi­smo and Mariani­smo. Conversations about the positive aspects of sexuality and sexual wellbeing are largely absent from current social work literature, education and practice. Often times, cultural stereotypes about acculturation, machismo and mariani­smo are perpetuated through risk-based approaches to understanding Latina sexuality. This study seeks to provide insight into factors correlated with sexual satisfaction for Latinas and to increase understanding of differences and similarities amongst Latina subgroups with respect to sexual satisfaction. This study is informed by Intersectionality and Latina Critical Race Theory; these theoretical approaches inform the research methodology and interpretation of findings by centering Latina identities and challenging stereotypes about Latina sexuality through a focus on positive aspects of sexual well-being. This is a cross-sectional, secondary analysis of Wave IV data from the 2008 National Longitudinal Study of Adolescent Health (Add Health) study. Wave IV includes a sample of 287 adult Latina women, who identified as either Mexican (56.9%), Chicana (6.7%), Cuban (4.2%), Puerto Rican (13.8%), and/or Central American (11.7%) or "other" (12.9%), with some identifying as multi-racial. The mean age of participants is 28 years. ANOVA analysis identified no significant group differences amongst Latina subgroups with respect to sexual satisfaction. Bivariate correlations indicated statistically significant associations between sexual satisfaction and relationship satisfaction. After controlling for income, education and religion, multiple regression analyses showed that relationship satisfaction, number of vaginal sex partners, and frequency of sexual relations were significantly correlated with sexual satisfaction. The more frequent engagement in sexual activity, and the more sexual partners one has is correlated with higher levels of sexual satisfaction. This study contributes to our knowledge of Latina sexual health, especially our understanding of factors that impact sexual satisfaction. For Latina women, health promotion programs should be designed to enhance interpersonal relationships that are based on mutual respect and care, utilizing culturally relevant approaches. Findings of this study challenge stereotypical cultural constructs related to acculturation, machi­smo and mariani­smo. This study shows that quality relationships built on trust, communication and love are strongly correlated with sexual satisfaction, which in turn should impact overall health. These findings support the recognition of positive aspects of sexuality as a critical site of intersectionality as Latinas of all ethnic groups in this sample report high levels of sexual satisfaction, as well as relationship satisfaction and support health promotion and intervention intended to support the cultivation and maintenance of meaningful relationships for Latinas.

What’s God got to do with Sex? Exploring the relationship between Spiritual engagement and the sexual health activities of Samoan youth. Improving the health and social wellbeing of Pacific youth is a key priority for the New Zealand Government. When the Pacific youth population’s sexual health is compared with that of other ethnic groups in New Zealand there are clear disparities. At the same time, spiritual engagement is frequently noted as protecting young people from engaging in health-risk taking behaviours. Objectives: This study determines whether a relationship exists between patterns of spiritual engagement and the sexual health activities of Samoan attending secondary schools in New Zealand. Does going to church or rating spiritual beliefs as important influence the sexual health activities of Samoan youth? Method: This research analyses data from ‘Youth 2000’, a youth health and wellbeing survey conducted in 2001. The survey was conducted with approximately 10,000 New Zealand secondary school students which included 646 Samoan and 5219 New Zealand Europeans. Nine sexual health activities were explored. Data relating to spiritual engagement and the sexual health activities of Samoan and New Zealand European students were extracted from the survey, measured and compared. Results: A significant proportion of Samoan youth have not had sexual intercourse. Just under a third of Samoan students (32.1%) have had sexual intercourse, with the average age of first sexual intercourse around 14 years. Findings reveal that the spiritual engagement variables: church attendance and the importance of spiritual beliefs have mixed influences on the different sexual health activities of Samoan youth. Conclusions: This study reinforces the central importance of spiritual engagement in the lives of many Samoan secondary school students. Government policies and interventions require an understanding of key health behaviours and their related risk and protective factors specific to New Zealand youth.

<p>The overall aim of this thesis was to examine the adoption of emergency contraceptive pills (ECP) in Sweden. Two cross-sectional surveys and two quasi-experimental studies were used. Reasons for induced abortion, contraceptive practices and contraceptive failure were examined in a group of abortion applicants with a waiting-room questionnaire (I) and knowledge, use and practices of ECP were assessed with a postal questionnaire in a population-based sample of young women (II). One community-based information campaign was evaluated with a repeated postal questionnaire (III) and a school-based education intervention was evaluated with repeated class-room questionnaires (IV). Abortion applicants had inadequate contraceptive practices and a low use of ECP. One year after the deregulation of ECP women were highly aware of the method and preferred the pharmacy for the purchase of ECP. Correct knowledge and positive attitudes influenced the willingness to use ECP in the future. The information campaign was noticed by two-thirds of the women and there was an overall trend towards better knowledge, improved attitudes and increased use among all women at follow-up. The school-based intervention improved the students’ knowledge of, and attitudes to, ECP without jeopardizing condom use. The adoption of ECP in Sweden seems to have gone through the first stages of diffusion of an innovation, i.e., developement, dissemination, and adoption, and has reached the stage of implementation since the studies indicated a general awareness of more than 90%, an intention to use in case of need of more than 70%, and womens’ own experience of use of around 30%. The most cited information channels were media, friends and the local Youth Clinic. ECP is gradually becoming a more widely known, accepted and used contraceptive method in Sweden, but must be considered as being only one of many tools in the prevention of unintended pregnancies.</p>

The overall aim of this thesis was to examine the adoption of emergency contraceptive pills (ECP) in Sweden. Two cross-sectional surveys and two quasi-experimental studies were used. Reasons for induced abortion, contraceptive practices and contraceptive failure were examined in a group of abortion applicants with a waiting-room questionnaire (I) and knowledge, use and practices of ECP were assessed with a postal questionnaire in a population-based sample of young women (II). One community-based information campaign was evaluated with a repeated postal questionnaire (III) and a school-based education intervention was evaluated with repeated class-room questionnaires (IV). Abortion applicants had inadequate contraceptive practices and a low use of ECP. One year after the deregulation of ECP women were highly aware of the method and preferred the pharmacy for the purchase of ECP. Correct knowledge and positive attitudes influenced the willingness to use ECP in the future. The information campaign was noticed by two-thirds of the women and there was an overall trend towards better knowledge, improved attitudes and increased use among all women at follow-up. The school-based intervention improved the students’ knowledge of, and attitudes to, ECP without jeopardizing condom use. The adoption of ECP in Sweden seems to have gone through the first stages of diffusion of an innovation, i.e., developement, dissemination, and adoption, and has reached the stage of implementation since the studies indicated a general awareness of more than 90%, an intention to use in case of need of more than 70%, and womens’ own experience of use of around 30%. The most cited information channels were media, friends and the local Youth Clinic. ECP is gradually becoming a more widely known, accepted and used contraceptive method in Sweden, but must be considered as being only one of many tools in the prevention of unintended pregnancies.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Även tryckt utgåva. Härtill 4 uppsatser.