Search

Introduction: Human immunodeficiency virus (HIV) and other sexually transmitted infection (STI) rates are increasing in rural areas, and adolescents and young adults are disproportionately affected. Data is severely lacking on rural primary care physicians' prevalence and comfort level in implementing sexual healthcare practices. Research has mostly focused on metropolitan or national samples. This study compared rural and urban primary care physicians' sexual healthcare practices and comfort providing these services to adolescent patients. Methods: A total of 510 family medicine and pediatrics physicians in the U.S. were recruited from a Qualtrics panel to complete an online cross-sectional survey between July 15-August 9, 2022. Rural-urban comparisons of performing and comfort level performing sexual healthcare practices were made with a chi-square test of independence and logistic regressions. Results: Chi-square test results showed that rural primary care physicians were less comfortable than urban physicians in asking an adolescent about their sexual risk behaviors, providing sexual risk counseling to an adolescent, testing an adolescent for HIV, and ordering an acute HIV test for an adolescent. Rural-urban differences were not seen in the logistic regressions. Conclusion: This study is the first to examine the sexual healthcare practices and comfort levels of rural primary care physicians. Future research must investigate the individual, organizational, and social determinants of rural primary care physicians delivering sexual healthcare services to their adolescent patients. Policy Implications: Medical schools, residency programs, and healthcare systems in rural areas or rural-majority states should invest in training opportunities and clinic resources that encourage rural primary care physicians to provide sexual healthcare services for their adolescent patients. [ABSTRACT FROM AUTHOR]

Introduction: Although cisgender adolescent sexual minority males and transgender and gender diverse adolescents (ASMM/TGDA) reported that their parents are key factors in using HIV pre-exposure prophylaxis (PrEP), research about the knowledge and attitudes toward PrEP among parents of ASMM/TGDA is scarce. We examined the PrEP-related information, attitudes, norms, self-efficacy, and intention of parents of ASMM/TGDA. Methods: From December 2021 to April 2022, 54 parents of ASMM/TGDA completed an online cross-sectional questionnaire adapted from the Information-Motivation-Behavioral Skill PrEP Scale. We analyzed data with descriptive analyses, regression analyses, and Mann–Whitney U tests. Results: Parents scored relatively low on their PrEP knowledge, but their attitudes and norms surrounding PrEP were generally positive. PrEP stigma was generally low. Parental self-efficacy and intention slightly decreased as the PrEP care continuum advanced. Compared to parents of sexually inactive adolescents, parents of sexually active adolescents scored higher in PrEP information, their intention to talk with their adolescent about PrEP, and their intention to get PrEP for their adolescent. Conclusions: Although parents of ASMM/TGDA may have heard of PrEP, they have low knowledge surrounding it. Creating opportunities for parents to increase their self-efficacy might increase their intention to participate in the PrEP care continuum of their adolescent. Parents of sexually active and inactive adolescents may require different intervention components. Policy Implications: Research and intervention development are needed to create online PrEP interventions that are created by and for parents of ASMM/TGDA. [ABSTRACT FROM AUTHOR]

Although HIV pre-exposure prophylaxis (PrEP) effectively and safely prevents HIV among adolescents, uptake of PrEP is low. Adolescents must have primary care providers (PCPs) prescribe them PrEP, making PCPs critical actors in PrEP delivery. However, research has primarily investigated determinants of PCPs' intention to prescribe adolescents PrEP rather than the determinants of performing the behavior itself. We examined the demographic, clinical practice, and implementation determinants of PCPs previously prescribing PrEP to adolescents. PCPs were recruited from a national Qualtrics panel of licensed medical providers in the United States from July 15-August 19, 2022. The Theoretical Domains Framework informed the implementation determinants measured. A multivariable logistic regression was used. PCPs who were more knowledgeable of the CDC guidelines (aOR 2.97, 95% CI 2.16–4.10), who were assigned male at birth (aOR 1.64, 95% CI 1.03–2.59), and who practiced in the Western region (aOR 1.85, 95% CI 1.04–3.30) had greater odds of prior prescribing adolescents PrEP. Provider-based educational interventions should be designed, implemented, and tested to encourage PCPs to prescribe PrEP to eligible adolescents. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article presents a study which examined U.S. men who have sex with men (MSM) and transgender women's behavioral changes and employed exposure mitigation strategies due to the monkeypox outbreak, as of August 26, 2022. Topics discussed include how monkeypox is transmitted, sociodemographic characteristics of the sample, and change in the sexual behaviors of the participants due to the monkeypox outbreak.

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 (χ2(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. [ABSTRACT FROM AUTHOR]

Co-occurring mental health (MH) problems are common among those with opioid use disorders (OUDs). However, most opioid treatment programs (OTPs) do not provide MH services. We measured the association between state level characteristics (Medicaid expansion status and rurality) and MH/OUD services integration. We used a generalized linear model to estimate how the association between integration and Medicaid expansions varied across levels of rurality (National Survey on Substance Abuse Treatment Services; 2018; n = 1507 OTPs). The predicted probability of OTPs offering MH services decreased as rurality increased, and the strength of the negative association was greater in non-expansion states (β =−0.038, SE = 0.005, p < 0.0001) than in expansion states (β =−0.020, SE = 0.003, p < 0.0001). Access to integrated MH services was lowest in rural non-Medicaid expansion states, despite the high risk of opioid misuse and a high need for MAT and MH services in this population. [ABSTRACT FROM AUTHOR]

Few studies have focused on within-group heterogeneity about specific factors that make lesbian, gay, or bisexual (LGB) Latinx adolescents at greater odds than other LGB adolescents for suicide We take a unique mixture-modeling approach by creating profiles of Latinx LGB adolescents based on suicide risk factors used in previous investigations (bullying, alcohol, sleep, social media, and poor grades). We use these profiles in a logistic regression to investigate suicidality A sample of 686 LGB, Latinx adolescents were used in a latent profile analysis yielding four distinct profiles. Class 4 represented the highest risk, with high rates of bullying, alcohol, poor grades, and use of electronics, while class 3 represented the lowest risk with low rates of bullying and alcohol Results speak to the need to address suicidal ideation through multiple factors, noting the strong association that both bullying and alcohol have with suicidal ideation. [ABSTRACT FROM AUTHOR]

Although men who have sex with men (MSM) within rural communities are disproportionately impacted by HIV, limited HIV research and programmatic resources are directed to these communities within the U.S. There is a need for improved behavioral data collection methods to obtain more detailed information on the relationship between rural environments, sexual behavior, and substance use. Utilization of mobile health (mHealth) technologies, such as ecologic momentary assessment (EMA), has been advocated for; however, limited research has evaluated its utility among rural MSM. Forty MSM residing in rural Oklahoma were recruited to complete in-depth interviews related to participating online/mobile-based HIV prevention research. Men described a willingness to participate in HIV and substance use studies that use EMA methodologies for data collection; however, they raised various research-related concerns. In particular, participants indicated potential privacy and confidentiality concerns related to the use of the mobile technology-based EMA in public and the storage of data by researchers. Given the varying degree of sexual orientation and substance use disclosure by participants, rural MSM were largely concerned with being inadvertently "outed" within their communities. Men described the various strategies they could employ to protect private information and methods to minimize research risk. Study findings suggest that EMA is an acceptable research methodology for use among rural MSM in the context of HIV and sexual health information, when privacy and confidentiality concerns are adequately addressed. Input from community members and stakeholders is necessary to identify potential areas of concerns for participants prior to data collection. [ABSTRACT FROM AUTHOR]

This study explores the role of faith leaders and congregations in preventing teen pregnancy and enhancing overall health. Seventeen faith-based leaders responded to an invitation to participate. Participants were recruited from two counties within Oklahoma, based on desired community characteristics. Findings were directly related to: (1) the vulnerability of rural communities to negative health outcomes; (2) resiliency of rural faith communities to address health issues; and (3) the adaptive capacity of rural faith leaders and their communities to decrease teen pregnancy and maximize community health. Culturally relevant public health programming is necessary to engage this at risk population; however, it requires engaging faith leaders in efforts to build congregation-based and community-based capacity. [ABSTRACT FROM AUTHOR]

Facilitators and barriers of Pre-exposure Prophylaxis (PrEP) uptake have been established in prior studies; however, most of these studies comprise samples of MSM from metropolitan cities and hypothetical PrEP use. There is a dearth of literature on the uptake factors among rural U.S. MSM who are prescribed PrEP. Thirty-four rural Midwestern MSM who currently take PrEP participated in semi-structured telephone interviews about their barriers and facilitators to their PrEP use. Interviews were analyzed using an inductive thematic analysis approach. There were four barriers: (1) lack of rural dissemination of PrEP information, (2) concern about side and adverse effects of using PrEP, (3) cost of PrEP uptake and engagement, and (4) lack of access to PrEP care and PrEP care quality. Individual and social facilitators that participants utilized to overcome these barriers are discussed. Findings elevate the importance of multilevel interventions that address PrEP adoption from a patient, provider, and healthcare system perspective. [ABSTRACT FROM AUTHOR]

The American College of Physicians has recently called for research to understand the potential causes of LGBT health disparities that exist when compared to their heterosexual counterparts. Barriers to accessing mental health care can be a cause of this disparity. To address this, the current study asked participants (N = 209) if they had received mental health care (MHC) over the past year and during their lifetime. Andersen’s (1967) behavioral health model was used to predict healthcare utilization. A hierarchical logistic regression was conducted to predict MHC, in the past year (12) and during their lifetime (L). Both models were significant: for MHC-L, (χ2(6) = 41.57, p < .001), and for MHC-12 (χ2(6) = 53.26, p < .001). Both models had previous mental health diagnosis and disclosure of sexual orientation status as significant predictors. Individuals who more openly disclosed sexual orientation status were more likely to have used mental health services. Implications and limitations to the study are discussed. [ABSTRACT FROM AUTHOR]

This study describes a modification of a sex-related expectancy measure to measure sex-related marijuana expectancies, and results were significant. Original research on expectancies for marijuana was conducted over 25 years ago. During this time period, attitudes, values, and beliefs regarding marijuana use are rapidly changing. This study examined if sex-related drug expectancies (SRDEs) predicted the frequency of marijuana use. By changing the prompt of a sex-related alcohol expectancy measure that instructed participants to focus on drug use, the study sought to measure SRDEs in a general adult population. An online survey was advertised on social media sites like Facebook and Craigslist. The SRDEs were assessed on N = 419 individuals (326 women, 93 men) who indicated using marijuana over the past 12-month period. A one-way ANOVA for women (p < .001) determined there were significant differences between SRDE scores for individuals, and post hoc analysis determined significant differences between infrequent and frequent marijuana users. Similar results were found for men using independent t tests. According to the SRDE, both male and female frequent marijuana users have higher sex-related expectancies when compared to infrequent marijuana users. With cultural changes influencing use of marijuana, measures like the SRDE that assess sex-related drug expectancies will help researchers understand how sex-related drug expectancies influence drug use. [ABSTRACT FROM AUTHOR]