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IntroductionThe United States (U.S.) has higher rates of sexually transmitted infections (STIs) and adolescent pregnancy than most other industrialized countries. Furthermore, health disparities persist among racial and ethnic minority adolescents (e.g., African American and Latinx) and in counties located along the U.S.-Mexico border region-they demonstrate the highest rates of STIs and unintended pregnancy among adolescents.MethodsQualitative data were collected as part of formative research for the development of a mobile app that provides gender-inclusive sexual education to adolescents living in the U.S.-Mexico border region. From August 2019 to March 2020, the study team conducted 11 in-depth interviews with healthcare providers and three focus groups with cisgender, heterosexual, and SGM adolescents ages 15-18 (n = 20).ResultsProviders and adolescents reported similar barriers to accessing SRH in this region such as transportation, lack of insurance and cost of services or accessing services without their parent's knowledge. However, providers shared that some adolescents in this region face extreme poverty, family separation (i.e., parent has been deported), have a mixed family legal status or are binational and have to travel every day from Mexico to the U.S. for school. These challenges further limit their ability to access SRH.ConclusionsAdolescents in the U.S.-Mexico border region face unique economic and social challenges that further limit their access to SRH care, making them uniquely vulnerable to STIs and unintended pregnancy. The prototype of the app was developed based on the needs expressed by providers and adolescents, including providing comprehensive Sex Ed and mapping of free comprehensive and confidencial SRH services available in the region and is being pilot tested. Our findings provide further evidence for the need for interventions and service delivery, programs tailored for residents in the border region.

BackgroundOver the past four decades, advances in HIV treatment have contributed to a longer life expectancy for people living with HIV (PLWH). With these gains, the prevention and management of chronic co-morbidities, such as diabetes, are now central medical care goals for this population. In the United States, food insecurity disproportionately impacts PLWH and may play a role in the development of insulin resistance through direct and indirect pathways. The Nutrition to Optimize, Understand, and Restore Insulin Sensitivity in HIV for Oklahoma (NOURISH-OK) will use a novel, multi-level, integrated framework to explore how food insecurity contributes to insulin resistance among PLWH. Specifically, it will explore how food insecurity may operate as an intermediary risk factor for insulin resistance, including potential linkages between upstream determinants of health and downstream consequences of poor diet, other behavioral risk factors, and chronic inflammation.Methods/designThis paper summarizes the protocol for the first aim of the NOURISH-OK study, which involves purposeful cross-sectional sampling of PLWH (n=500) across four levels of food insecurity to test our conceptual framework. Developed in collaboration with community stakeholders, this initial phase involves the collection of anthropometrics, fasting blood samples, non-blood biomarkers, 24-hour food recall to estimate the Dietary Inflammatory Index (DII®) score, and survey data. A 1-month, prospective observational sub-study (total n=100; n=25 for each food security group) involves weekly 24-hour food recalls and stool samples to identify temporal associations between food insecurity, diet, and gut microbiome composition. Using structural equation modeling, we will explore how upstream risk factors, including early life events, current discrimination, and community food access, may influence food insecurity and its potential downstream impacts, including diet, other lifestyle risk behaviors, and chronic inflammation, with insulin resistance as the ultimate outcome variable. Findings from these analyses of observational data will inform the subsequent study aims, which involve qualitative exploration of significant pathways, followed by development and testing of a low-DII® food as medicine intervention to reverse insulin resistance among PLWH (ClinicalTrials.gov Identifier: NCT05208671).DiscussionThe NOURISH-OK study will address important research gaps to inform the development of food as medicine interventions to support healthy aging for PLWH.

In response to the COVID-19 pandemic, large swaths of the U.S. were under stay-at-home orders, thus preventing many individuals from leaving their homes. While previous studies have shown that such orders can be detrimental to mental health, specific mental health outcomes, such as loneliness and anxiety, have yet to be fully explored, particularly among various living situation contexts (e.g., living alone, with romantic/sexual partners, without romantic/sexual partners). The current study explores this using a mixed-methods approach. Data were collected via Amazon's M-Turk (N = 85). Kruskal-Wallis tests revealed significant differences between the three groups with respect to loneliness. Statistically significant greater levels of loneliness were found in individuals living alone compared to those living with romantic/sexual partners and those living with non-romantic/sexual partners. No significant differences in anxiety levels were detected. Qualitative analysis revealed similar themes among all groups regarding anxiety. When asked about loneliness, however, those living alone shared more about feeling isolated, unwanted feelings of solitude, and how technology only mitigates a portion of these feelings. Those living with others and sexual partners shared desires to see friends and co-workers, yet not to the severity described by individuals living alone. Romantic/sex life themes are also discussed., Author(s): Joseph M. Currin [sup.1] , Amelia E. Evans [sup.2] , Bridget M. Miller [sup.3] , Christopher Owens [sup.4] , Zachary Giano [sup.5] , Randolph D. Hubach [sup.6] Author Affiliations: [...]

There is a paucity of research analyzing sexting behaviors in adults aged 25 and older. The majority of research into sexting focuses on emerging adult populations and adolescents. While sexting has been studied in regard to relational attachment and motivations to sext, little is known about how these constructs are associated with older adults' sexting behaviors and how they relate to the type of sext message sent. To that end, the current study sought to predict the type of sext message (image or text only) sent based on relational attachment and sexting motivations. A significant logistic regression model was found ([chi]2(6) = 51.97, p < .001), with relational anxiety and body image reinforcement being significant predictors of adults sending a partially and/or nude image in a sext message. Interestingly, gender was not a significant predictor. Gender not being a significant predictor differs from research into emerging adult relational attachment styles and sexting behaviors. Individuals who sexted for body image reinforcement were more likely to send an image as a sext message. Those who were higher on relational anxiety were less likely to send an image as a sext message., Author(s): Joseph M. Currin [sup.1] , Brittney L. Golden [sup.1] , Randolph D. Hubach [sup.2] Author Affiliations: (1) grid.264784.b, 0000 0001 2186 7496, Department of Psychological Sciences, Texas Tech University, [...]

Objective: To explore experiences, beliefs, and information-seeking behavior around COVID-19 among college students in Oklahoma. Participants: Fifteen college students participated during the pandemic period from April to July 2020. Methods: An exploratory, qualitative research approach method was used to discover students' experiences, beliefs, and information-seeking behaviors around COVID-19. Exploration of beliefs was guided by the Health Belief Model. Results: Students engaged in COVID-19 information-seeking behaviors predominantly through Internet sites, broadcast news, health professionals, and governmental sources. Students experienced emotional burden as a result of COVID-19 misinformation in these sources. While most students perceived a low chance of acquiring the virus due to their lack of underlying medical conditions, they were still concerned about the consequences of becoming infected. Students noted the difficulty of physical distancing while on campus. Conclusions: Colleges/universities should maximize the dissemination of timely, valid health information for the safety of their students and the broader community. [ABSTRACT FROM AUTHOR]

Because most parent-adolescent sex communication studies are from the perspectives of sexual and gender minority (SGM) adolescents rather than their parents, we surveyed 54 parents of SGM adolescents in the Southern region in the U.S. about their HIV-related parent-adolescent sex communication (PASC) practices. We compared topics discussed between the sexual activity and sexual orientation/gender identity of their adolescent. We found significant differences between parents having a sexually-active adolescent or not and parents discussing the importance of using condoms and what their adolescent should do if the adolescent contracts HIV. We provide future directions to further examine and improve PASC between parents and their SGM adolescents. [ABSTRACT FROM AUTHOR]

The information shared in schools on sex education in the USA is highly variable depending on the state and sometimes city in which a student lives. Gay and bisexual students living in a socially conservative, primarily rural state such as Oklahoma often receive little information about sexual health information that pertains to their behaviours unless it is discussing the dangers of sex. Using a qualitative approach, 20 gay and bisexual men currently residing in Oklahoma completed semi-structured interviews about their experiences with sex education and alternate ways to compensate for lack of information provided. Participants noted an awareness of the lack of meaningful sex education or if it was offered, a primary focus on abstinence-only until marriage heteronormative curricula. Participants described various ways they compensated for lack of sex education including accessing pornography and information from the internet. With the current socio-political environment of Oklahoma, it is unlikely wholesale changes to the sex education curricula can be made. The importance of public health professionals using the internet and peer educators to deliver inclusive and informative sexual health information remains salient and viable for men who reside in socio-politically conservative areas like Oklahoma.

Primary care providers (PCPs) are critical in prescribing human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) to adolescents at risk of HIV. More research is needed to identify facilitators and barriers PCPs encounter in prescribing PrEP to eligible adolescents post-Food and Drug Administration (FDA) approval. This online cross-sectional survey examined the PrEP implementation facilitators and barriers among a national sample of PCPs in the United States. PCPs (n = 502) specializing in family medicine or pediatrics were recruited from a Qualtrics panel from July 15 to August 9, 2022. We analyzed the collected data using content analysis and applied the Expert Recommendations for Implementing Change (ERIC) to codebook creation and data analysis. We conducted a Fisher's exact chi-square test of independence to compare facilitator and barrier prevalence differences between participants who had and had not prescribed PrEP to an adolescent patient. Results demonstrate that (1) distributing prescriber-focused educational materials, (2) involving parents, (3) changing liability laws, (4) enhancing adolescent PrEP uptake and adherence, (5) changing clinical resources, and (6) using mass/social media to change community norms might be strategies that influence PCPs prescribing PrEP to eligible adolescent patients. Results from this study could facilitate the planning of hybrid implementation-effectiveness trials designed to determine the acceptability, feasibility, and effectiveness of implementation strategies in improving the practices of PCPs prescribing PrEP to at-risk adolescents. [ABSTRACT FROM AUTHOR]

Purpose: An outbreak of the monkeypox virus has been documented in the United States with most cases occurring among gay, bisexual, and other men who have sex with men (MSM). As monkeypox cases increase among relatively rural states, current public health messaging may not resonate with rural at‐risk populations. Given this, there is a need to assess potential rural‐urban differences in monkeypox behaviors and attitudes among MSM. Methods: A total of 582 eligible MSM completed an online cross‐sectional survey between August 6 and 15, 2022. Participants answered questions about their demographics, sexual behaviors, monkeypox testing and vaccination behaviors, monkeypox media consumption and attitudes, and their intention and attitudes found in the Health Belief Model of getting the monkeypox vaccine. Rural‐urban differences in behaviors and attitudes were assessed with a chi‐square test of independence. Differences in intention to get vaccinated and Health Belief Model factors were assessed with a Mann‐Whitney U test. Findings: Rural MSM, in comparison to their urban counterparts, were found to be less likely to report modifying their behaviors to decrease monkeypox exposure, being susceptible to monkeypox, or perceiving severe consequences acquiring monkeypox. Similarly, rural MSM had a lower intention to get vaccinated for monkeypox. Conclusions: As vaccination uptake among rural populations for vaccine‐preventable diseases remains suboptimal, results from this novel study can inform the development of monkeypox prevention, testing, and vaccination messaging campaigns geared toward rural MSM and other at‐risk populations. It will be important to ensure that monkeypox prevention, testing, and vaccination interventions are available and accessible in rural areas. [ABSTRACT FROM AUTHOR]

Although parents of sexual and gender minority (SGM) adolescents are key stakeholders in SGM adolescents using HIV pre-exposure prophylaxis (PrEP), there is limited understanding of parental concerns and attitudes about their SGM adolescents taking PrEP. Fifty-four parents in the West South Central region of the U.S. completed an online, mixed-method, cross-sectional questionnaire to explore their concerns and questions about PrEP. Quantitative and qualitative results show that participants were more concerned about side effects, drug interactions, (non)adherence, and eligibility and duration of PrEP. Parents are less worried about picking PrEP from a pharmacy or returning to follow-up lab testing every three months. Most parents reported receiving medication information their adolescent takes from a medical provider and the media. Findings from this study can inform the development of parent-based PrEP interventions. Without further parent-based research and programming, SGM adolescents may continue to be disproportionately affected by HIV. [ABSTRACT FROM AUTHOR]

HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers' lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to August 2019, 15 HIV service providers participated in a one-hour semi-structured telephone interview that elicited their experiences working in the rural HIV care continuum. Participants were tired of constantly educating and working to reduce HIV stigma; however, they received support from family and friends once they educated them about HIV. Participants felt they lacked control over systems and they developed emotional-based coping to address constant occupational stressors. Findings highlight the importance of resiliency and advocacy research and practice across ecological levels. [ABSTRACT FROM AUTHOR]

Sexual minority men have consistently shown to be at-risk for adverse mental health outcomes due to minority stress, yet studies show some men successfully navigate these barriers. What is less known are the environmental and social/emotional factors to which minority stress is amplified (or attenuated). We comparatively investigate rural versus urban sexual minority men and how levels of 'outness' (the degree to which an individual discloses their sexual identity to others around them) interacts with gay-related rejection anxieties (a specific type of minority stress). Results broadly show that 1. higher levels of gay-related rejection are statistically associated with higher levels of loneliness, and 2. outness moderated this link in rural, but not urban men. In other words, higher levels of outness amplified the deleterious effects of gay-related rejection in the rural sample only. Although previous research shows mixed results in regards to how coming out affects the mental health of sexual minority men, our stratified results show that rural men may be at a higher risk for deleterious mental health with higher levels of outness. Implications from this study bolster the mental health field, particular mental health practitioners working with rural sexual minority men and the aftermath of coming out. [ABSTRACT FROM AUTHOR]

Adverse Childhood Experiences (ACEs) show predictive utility concerning binge drinking. However, the literature is limited by 1. a focus on cumulative ACEs with little regard to specific domains, 2. a focus on those with the highest ACE scores, and 3. little consideration for gender differences. These approaches are problematic as ACE categories are fundamentally different, yet little distinction is given to specific ACE domains. The current study investigates which individual and dual ACE domain combinations are associated with binge drinking. Data were obtained from the Behavioral Risk Factor Surveillance System (2011-2017; N = 80,391). A series of ANCOVAs were conducted to determine the association between single and dual combination ACE domains and binge drinking. Results show gendered effects of ACEs on binge drinking such that at 0, 1, and 2 ACEs, males reported statistically higher rates. For males with exactly two ACEs, combinations of either sexual abuse or family incarceration presented the highest levels of binge drinking- with the highest mean binge drinking score being the exact combination of the two. This contrasts with males with 1 ACE, where experiencing family incarceration or sexual abuse, as a single domain, did not represent significant risk above the average of having a single ACE. Results suggest that males may be resilient to either of these domains as singular events, yet when found in combination, may present a synergistic effect that increases the likelihood of binge drinking. Due to lower overall binge drinking rates, no significant patterns were found among females. [ABSTRACT FROM AUTHOR]

Rural men who have sex with men (MSM) experience numerous barriers to healthcare, including stigma, which impedes medical and mental healthcare engagement. Given this, rural MSM are less likely to be engaged in routine healthcare compared to their urban counterparts. Telemedicine has been advocated for to address these disparities in care access; however, no known studies have explored the amenability of telemedicine for both medical and mental healthcare among rural MSM. In-depth interviews were conducted with a sample of MSM (n = 23) residing in rural Oklahoma and Arkansas. Respondents described a willingness to use telemedicine to engage with medical and mental health providers as it presented a mechanism to overcome identified barriers to care. Removing barriers, notably lack of access to knowledgeable and affirming providers, is one potential method for increasing engagement in routine care which provides opportunities for rural MSM to engage in primary and secondary prevention services. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) uptake has been suboptimal despite its demonstrated efficacy in reducing the risk of HIV acquisition. Medical education is one distal determinant that shapes medical providers' perceived role in the PrEP care continuum. However, there is limited understanding of how osteopathic medical students and those wanting to practice in rural areas perceive their role in the PrEP care continuum in the domains of PrEP awareness, uptake, and adherence and retention. Twenty-one semistructured interviews were conducted (March 2019–April 2020) to assess what shapes osteopathic medical students' perceived role in the PrEP care continuum. Participants noted a lack of adequate sexual health training, personal perceptions concerning PrEP use, and ambiguity concerning which of the medical specialties should deliver PrEP. Osteopathic medical schools can incorporate more inclusive and holistic sexual health and PrEP curricula to address these barriers and better prepare osteopathic medical students for their future role in the PrEP care continuum. [ABSTRACT FROM AUTHOR]